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7/78 III III III III I'll III . APPLICATION CHECKLIST <br />REGULAR 112 APPLICATION NAME ''P:* 15" FILE N8"D-18' <br />COMPLETE (FILED) DATE Seete».bBr ~1,~ i98a <br />ITEM <br />COMPLETE ADEQUATE COMMENTS <br />Application form: <br />1. Name of operation <br />2. Name of applicant <br />3. Address 6 phone, local <br />4. Address ~ phone, general <br />5. Person to contact ~ <br />6. Parent Corporation, if any <br />~C <br />7. Surface Owners <br />JC <br />~~ <br />8. Mineral Owners <br />9. Source of Legal Right-to-Enter <br />10. Type of Mine/Substance <br />11. General Location E Elevation y` <br />12. County r~ <br />13. Acreage <br />14. Fee I \ / <br />J~ <br />15. Present Land Use <br />16. Surrounding Land Uses <br />17. Proposed Future Use Sa.+~+ m~-h ~„ of w5~ of is kPS <br />18. Unpermitted Mining Operations <br />19. Affected Lands ~ / <br />J'_ ~_ <br />20. Signature v 7C <br />(over) <br />