PERMFILE66955

• Permit No: M1978052
• IBM Index Class Name: Permit File
• Doc Name: REGULAR 112 PERMIT APPLICATION CHECKLIST
• Media Type: D
• Archive: No

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ML*iED LAND RECLAMATION _ r1_ _
Re¢ular (I~) Permit Avplication CheeLlis~ ~~I ~Illf ~'Jf f rIl f~I
File :do. 7g-s~ Name ~b,~/.p 'Pre, -~ ~ Date of Filing (Completeness)
ITE2•f COMPLETE ADEQUATE COZQLEN'2S
Aopllcation Fotm
1. Name of operation /
2. Name of applicant
3. Address 6 phone (local offices) ' ~
G. Address b phone (gea'l. offices) I ~ '
5. Person to contact ~ ~_
6. Parent corporation (if any) I ~--
7. Surface owners I ~
3. *ti.neral owners ~
i

9. Type of mine/substance ~' I
~.0. General location S eizvation i _
I~
1. County ~ ~
I ~
.2. Acreage ~ ~~ ~
~3. Fee
I
,4. Present land use
I

I
.f. Surrounding land uses I '~
.o. Proposed future use '' ~

.7. Other mining permits ~ 1
.8. Signature `- ~
.9. Prohibited Loads Statement
'Fans fi Exhibits
1. Legal description
~-~°
2. Zndex man --
j
3. Pre-mining 5 mining plan map i
4. Pfining plan - a) timetable .~ I
- }fi rjonrn .C rni r'vn ccc nt I
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