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4/77 <br />• MINED LAND RECLAMATION • <br />Regular (112) Permit Application ChecY1 ist <br />File :40.77-3G~ Name /"Q.,~~ CCc.c.,..'~•i Date of Filing (Completeness): <br />ITEi•I COMPLETE ADEQUATE COMIfENTS <br />Application Form <br />1. Name of operation <br />i <br />/ <br />C <br />/' <br />/ <br />2. Name of applicant / <br />/ <br />w ` <br />~ <br /> <br />3. Address fi phone (local offices) <br />~v i <br />4. Address fi phone (gen'1. offices) // <br />5. Person to contact ~ ~ <br />I ~, <br />6. Parent corporation (if any) ~ J <br />7. Surface owaers <br />3. t4ineral owners i C~ , <br />9. Type of mine/substance l~ ~ <br />0. General location b elevation 11~ <br />.1. County ~ ~~ <br />.2. Acreage ~'~ I f~ ~o yon wow...-'} R, <br />1 i- < < -Fc-+e~ ~9 ~c <br /> <br />.3. Fee ~ <br />I/ /v e-e a <br />~ O-F c 2~~ ~~ <br />.4. Present land use ! ~ <br />.5. Surrounding land uses I <br />.6. Proposed future use <br /> <br />.7. Other mining permits l / <br />v <br />.8. Signature <br />.9. Prohibited Lands Statement <br />:taps fi Exhibits <br />1. Legal description <br />,~ <br />2. Index map <br />3. Pre-mining fi mining plan map <br />4. Mining plan - a) timetable <br />- b) depth 6 thickness of ore I <br />~~J <br />rm,R <br />X~, <br />b0 y <br />