REV07205

• Permit No: M1986076
• IBM Index Class Name: Revision
• Doc Date: 11/25/1987
• Doc Name: LIMITED IMPACT OPERATION 110 APPLICATION FORM
• Type & Sequence: AM1
• Media Type: D
• Archive: No

-2
' 10. Correspondance Information
APPLICANT/OPERATOR (name,
Individual's Name: w
Company Name: N
Street:
City:
State:
' Area Code:
PERMITTING CONTACT (if di
Individual's Name:
Company Name:
~. Street:
City:
State:
Area Code:
INSPECTION CONTACT (if di
Individual's Name:
Company Name:
' Street:
City:
State:
Area Code:
~~' Contact Ed Wolf at (30
11. Primary future ^ Cropla
land use ^ Rangel
(check one): ^ Reside
' ^ Develo
12. Primary present ^ Cropla
land use ^ Rangel
(check one): ^ Reside
_ ^ Develo
To the best of my knowledge, al
the attached Exhibits A-G are t
' Date: y A/o~ /q87
address, and phone of name to be used on permit)
ill Samland
INC
NE
ALS
.
,
ORTHERN MI
R
300 Town Center, Suite 5710
Southfield.
Michigan Zip Code: 48075
313 Telephone: [phone]
fferent from applicant/operator above)
Will Samland/E ard~G. Wolf
NORTHERN MINERALS, INC.
1436 Tiooerary
Boulder,
Colorado Zip Code: 80303
303 Telephone: [phone]
fferent from applicant/operator above)
Will Samland
NORTHERN MINERALS, INC.
Idaho Mill
MayDay
Colorado Zip Code: -----
TelephORe: Seasonal - No Phone~~'
3) 666-5160, he will know the seasonal number.
nd(CR) ^ Pastureland(PL) ^ General Agriculture(GA)
and(RL) ^ Forestry(FR) ® Wildlife Nabitat(WL)
ntial(RS)p Recreation(RC) ^ Industrial /Commerrial(IC)
ped Water Resources(WR) ^ Solid Waste Disposal(WD)
nd(CR) ^ Pastureland(PL) ^ General Agriculture(GA)
and(RL) ^ Forestry(FR) ® Wildlife Habitat(WL)
ntial(RS) ^ Recreation(RC) ^ Industrial /Commercial(IC)
ped Water Resources(WR)
1 the information presented on this application form and
rue and correct (must be signed by applicant/operator).

/ r Ci a_
Tl e