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.. - _ _ - - - <br />7/78 • APPLICATION CHECKLIST ~ III III'lllll'~IIIII + <br />REGULAR 112 APPLICATION NAME S.~;der~s !{ ,¢ utQ ~~~. FILE~~?7-193 <br />COMPLETE (FILED) DATE ~Jtine 4 /i$~ <br />ITEM COMPLETE ADEDUATE COMMENTS <br />Application Form: <br />I. Name of operation <br /> I K <br />2. Name of applicant <br /> <br />3. Address E phone, local <br /> i X <br />4. Address E phone, general <br /> <br />5. Person to contact <br />I <br />6. Parent Corporation, if any i <br />i <br />7, Surface Owners ~ <br /> yc <br />8. Mineral Owners ~ <br /> <br />9. Source of Legal Right-to-Enter <br /> x ~ <br />10. Type of Hine/Substance <br />11. General Location E Elevation <br /> ~~ <br />12. County <br /> 5-G <br />13. Acreage <br /> ~~ 3~ <br />14. Fee <br />15. Present Land Use <br /> x x <br />16. Surrounding Land Uses `` <br />' <br /> / <br />\ <br />17. Proposed Future Use <br />18. Unpermitted Mining Operations <br />19. Affected Lands <br />20. Signature <br />(over) <br />