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4/~,- - ~ ~ i~l ~iii~~iiilr~ii~~ <br />999 <br />MINED LADID RECLAI~L4TIOtr <br />LIMITED IZIPACT A~W SPECIAL 10-DAY PERMIT APPLICATION CHECKLIST <br />File No. 7~_4s9Name Lu ka C~~.~F~ Grn~~l cif Date of Filing (Completeness) <br />ITEM COMPLETE ADEQUATE COMPSEi1TS <br />Application Form <br />1. Name of operation <br />V/ ' / <br />~/ <br />2. Name of applicant/operator ~/ lip <br />3. Address 6 phone (local offices} ~ v- <br />4. Address 6 phone (general offices) ~/ ~~- <br />5. Person to contact ~/ ~j~ <br />6. Surface owners ~/ (~~ <br />7. Piiaeral owners ~~. <br />8. Type of mine/substance ~ Lam. <br />9. General locatioa & elevation *~ L~_ <br />I0. County V~ / - ~ <br />11. Acreage ~/ <br />12. Fee P.~-- o _~- :~-J, c>(~ <br />13. Present land use 1/• ~~• <br />14. Proposed future use V <br />r.- <br />15. Signature G/' <br />Maps and Exhibits <br />1. Exhibit A - Legal description . / <br />"' ' ^ <br />T/ <br />2. Exhibit B - .fining plan ~~~ <br />3. Exhibit C - Map / ~- <br />,~ <br />4. Exhibit D - Wildlife~irater R sources, <br />Vegetal a and Soils~.'nfor- <br />oration <br />~/ <br /> <br />5. Exhibit E - Reclamation plan / <br />~/ ~ ., <br />