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7/'2 <br />LIMITED li".PACT (l10) ~. <br />cpe,:iAL 10-JAY (Ill) <br />-------------------------- <br />ITD_M <br /> <br />4 <br />MARE R~ P' B: ei~'"' _ 8:.,.~Hw~, C~..sh;~„' F[L_ '~a_ <br />CO~PLcTc C=1L.p} JaTc <br />G~DI ~ <br />c ,.. T aoE•~uaT= Ccrr,_uls <br />.~oolicatien Fain: <br />1. ?lame of operation ' <br />~ <br />~ I( <br />2. Yar,.e of applicant/operator I .~ <br />3. Address E phone, local I `/ <br />^ I ~ <br />f <br />y. nddress ~ phone, genera; I }< ` X <br />j. Person to contact ~ I x I <br />6. Surface owners <br />7. Mi~;eral owners I ~ I x <br />8. Source of iegai right-ta-enter J X ~ r <br />? Type of mine/substance I " I ~ <br />1G. General Iecaticn s elevation I •~ <br />11. County I I <br />x I <br />x I <br />i?, Acreage I ~. <br />1~• °-- I ~ ~ x ~ Mop Pa,~ <br />I=•. Prese^.t land use ~ <br />1j• Prcocsed future use ~ I ~• <br />/` ! <br />16. Signature I ~ I 1/ <br />/~ f <br />Laos and Exhibits <br />EXrii3IT A - Legal Description <br />\/ _ - <br />5::4131T B - Mining Pian ( x <br />EXM131T C - Nap <br />I <br />_ <br />EX'r. al D - 4ildl-JJ`e, '»a terJ.'.e curses, <br />`leae2'a~ion, Soils~~n~or-a-icn i <br />'~7 I <br />/\ <br />~ <br />tl eed A q 'nt~fe <br />{VO 4UY y VecF'vd. <br />