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999 <br /> MINED LAND RECLAMATION <br /> Application Worksheet/Checklist <br /> Regular 112 Application Name . G1th5 P, File No. M 97184 <br /> ceM,khw5s Avi:..A.W.a; 611SISV Cwnp}ecQ i e Date Llu K, J988 <br /> &MrA1i dii�/a4 <br /> ITEM COMPLETE ADEQUATE COMMENTS <br /> Application Form: <br /> 1 . Name of Operation Ok <br /> 2. Name of Applicant/Operator k <br /> 0 <br /> 3. Address & Phone (Local ) ok <br /> 4. Address & Phone (General) k <br /> 0 <br /> 5. Person to Contact <br /> ok <br /> 6. Parent Corporation, if any ek <br /> 7. Surface Owners ak <br /> 8. Mineral Owners d <br /> 9. Source of Legal Right-To-Enter pk <br /> 10. Type of Mine/Substance ok <br /> 11 . General Location & Elevation ok <br /> 12. County ok <br /> 13. Acreage k 0 <br /> 14. Fee 7A'! -r'�•se <br /> ok <br /> 15. Present Land Use k <br /> 0 <br /> 16. Surrounding Land Uses Ok <br /> 17. Proposed Future Use 6K <br />