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7/78 APPLICATION CHECKLIST <br />E~a.n ~e~$.'fi~n InC, <br />REGULAR 1 12 APPLICATION NAME 4 ~/a r n ev.~ P: f " F I LE H ~0 -~5 <br />--ff <br />COMPLETE (FILED) DATE O'~a y S , 1 sF, <br />--------------------------------------------------------------------------------------------- <br />ITEM <br />COMPLETE ADEQUATE COMMENTS <br />Application Form: <br />1. Name of operation ~ <br /> ~ <br />2. Name of applicant >~ <br />3. Address b phone, local <br /> x <br />4. Address b phone, general <br /> i <br />5. Person to contact <br /> <br />6. Parent Corporation, if any <br /> ~ ~ <br />7. Surface Owners <br />8. Mineral Owners JC <br />9. Source of Legal Right-to-Enter ~ C~ <br />10. Type of Mine/Substance <br /> ~ X <br />11. General Location b Elevation <br />12. County <br />13. Acreage <br />14. Fee <br /> x <br />15. Present Land Use <br />16. Surrounding Land Uses <br /> <br />17. Proposed Future Use <br />18. Unpermitted Mining Operations <br /> <br />19• Affected Lands <br />20. Signature <br /> ~_ <br />(over) <br />