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7178 ~ APPLIC.:T!OY C-~CLIST III III'IIIII~III'll <br />rI CMG ~ye /dp n~u y" j„c. <br />LIMITED IMPACT (110) ~ NA?tE Ne~k~t.d r:„t••• FILE 2~l-i6.5 <br />SPEC 1 AL I 0-DAY ( I 1 I ) ~, COMPLETE (F 1 LEU) DATc fluy 7, I s P ~ _ <br />ITEM <br />COMPUTE ADEQUATE . COMME"JTS <br />Aoolication Form: <br /> <br />1. `Jame or operation I - <br />2. Name of applicant/operator 1 <br />I <br />3. Address b phone, local I <br />4. Address b phone, general ( <br />5. Person to contact <br />6. Surface owners <br /> <br />x I <br />I -- <br />7. Mineral owners <br /> ~ _ <br />8. Source of legal right-to-enter I <br />9. Type of mine/substance ( 4 <br />I <br />f X l __ <br />10. General location E elevation I ~ <br />, <br />. ~ u _. <br />11. County ( ( <br /> ~ _ <br />12. Acreage I <br /> -~ _ <br />to °e I I <br /> h <br />14. Present land use <br /> X ~ <br />15. Proposed future use I LG/~2;k5'' ~.. h/dldr;l~ N!,:~~7 <br /> ~ ` ~ <br />16. Signature <br /> >~ <br />Haos and Exhibits _ ._ <br />EXHIBIT A - Legal Description <br />x ;~ 4 ? <br />EXHIBIT 9 - Mining Plan <br /> I/...r ~,rr Pvu~ss if.~9re.„. <br />EXNI9JT C - Nap hre-, oa}<a r. <br /> ~< <br />/ J <br />EXii IEIT D - `di ldl i fe, `dater Res<:urces, <br />~ <br />`leget~ation, Soils~lrifornation - <br />