Laserfiche WebLink
J/78 III III III IIIIIII III ~ APPLICATION CHECKLIST • <br />7- <br />REGULAR 112 APPLICATION NAME '~•~ ~~ FILE N~ <br />COMPLETE (FILED) DATE <br />ITEM <br />COMPLETE ADEQUATE COMMENTS <br />Application Form: <br />1. Name of operation <br />2. N~3me of applicant <br />3. Address & phone, local <br />4. Address 6 phone, general I <br />5. P~:rson to contact I <br />6. Parent Corporation, if any <br />7. Surface Owners <br />8. Mineral Owners I <br />9. Source of Legal Right-to-Enter <br />10. Type of Mine/Substance <br />11. General Location b Elevation <br />12. founty <br />13. Acreage <br />14. Fee <br />15. Present Land Use <br />!6. Surrounding Land Uses <br />17. Proposed Future Use <br />18. Unpermitted Mining Operations <br />19. Affected Lands <br />20. Signature <br />(over) <br />