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4/77 III IIIliilllllii III <br />999 <br />~fINED LAND RECLAMATION <br />Regular (112) Permit Application Checklist <br />File Io. ~~"ZOf6 Name ~Iartm-lilariett~.: (eons C~mcnt Date of Filing (Completeness) <br />ITEi•1 COMPLETE ADEQUATE COMMENTS <br />Application Form <br />1. Name of operation <br />2. name of applicant <br />3. Address S phone (local offices) I / <br />4. Address b phone (gen'1. offices) <br />S. Person to contact j <br />6. Parent corporation (if any) / <br />7. Surface owners / i <br />3. Piineral owners / <br />- / <br />9. Type of mine/substance / <br />.0. General location b elevation ~ / <br /> <br />.1. County <br />~ 1/ r ; <br />j <br /> <br />2. Acreage i <br />.3. Fee <br />~ i <br />' <br />.4. Present land use ~ / <br />.~. Surrounding land uses / <br />.6. Proposed future use / <br />7. Other mining permits <br />.8. Signature / <br /> <br />9. Prohibited Lands Statement / <br />~/ <br />~ <br />'aps 6 Exhibits <br />1. Legal description <br /> ~ <br />2. Index map <br /> / <br />3. Pre-mining fi mining plan map <br />i <br />4. Mining plan - a) timetable ~ <br />- b) depth ~ thickness of ore j <br />~~ <br />i <br />DOOM <br />