Laserfiche WebLink
j. .� � • III III'lllll"II'II <br /> sss <br /> I <br /> MINED LAND RECLAMATION <br /> Application Worksheet/Checklist <br /> �rt it} fi3 'SZ Regular 112 •APPHE44-c-a#�i�en, Name •o •, File No. <br /> Complete Filed Date <br /> ITEM COMPLETE ADEQUATE COMMENTS <br /> Application Form: <br /> 1 . Name of Operation �( <br /> 2. Name of Applicant/Operator ` <br /> 3. Address & Phone (Local ) <br /> 4. Address & Phone (General ) <br /> 5. Person to Contact <br /> 6. Parent Corporation, if any <br /> 7. Surface Owners <br /> 8. Mineral Owners <br /> 9. Source of Legal Right-To-Enter y <br /> 10. Type of Mine/Substance 7� <br /> 11 . General Location & Elevation <br /> 12. County <br /> 13. Acreage ? <br /> 14. Fee f" <br /> 15. Present Land Use <br /> 71 <br /> 16. Surrounding Land Uses x <br /> 17. Proposed Future Use P( <br />