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: 7/78 ~ O APPLICATION C4ECKLIST O <br />"Vollmer Or * ~~ <br />REGULAR 112 APPLICATION NAME I tr~~ Gons~r„~~:o~ Inc. FILE ~` ~3-$5 <br />COMPLETE (FILED) DATE I"lti~~Gi /ire l 9~3 <br />---------------------------------------------------------------------------------------------- <br />ITEM <br />COMPLETE ADEQUATE COMMENTS <br />Application Form: <br />1. Name of operation ~ X <br />2. Name of applicant ~ <br />3. Address z: phone, local ~ <br />~ I <br /> ' ~ <br />4. Address E phone, general <br /> ~ I <br />5. Person to contact <br /> x ~ ~ <br />6. Parent Corporation, if any <br /> ~ <br />7. Surface Owners i I <br /> ~ <br />~ <br />8. Mineral Owners ~ ~ <br /> ~ <br />9. Source of Legal Right-to-Enter ! ` <br /> ~C I <br />10. Type of Mine/Substance <br />X <br />11. General Location E Elevation <br /> X <br />12. County <br /> x ,c <br />13. Acreage ~ <br /> x x <br />14. Fee J~ <br />IS• Present Land USe <br />16. Surrounding Land Uses <br /> ~~ ~ <br />17. Proposed Future Use ~ <br />18. Unpermitted Mining Operations <br />x <br />i <br />19. Affected Lands <br /> ~G X <br />20. Signature <br /> 5~ <br />{over) <br />