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'~ - ~ • • III IIIIIIIIIIIIIIII <br />999 <br />MINED LAND RECLAMATION <br />Application Worksheet/Checklist <br />Regular 112 Application Name CASTLE vn1 re File No. ~Z/O <br />Complete Filed Date /o ~& ~ <br />ITEM COMPLETE ADEQUATE (:OMMENTS <br />Application Form: <br />1. Name of Operation <br />2. Name of Applicant/Operator <br />3. Address & Phone (Local) <br />4. Address & Phone (General) 1~ <br />5. Person to Contact <br />6. Parent Corporation, if any <br />1. Surface Owners / ~ <br /> <br />8. Mineral Owners <br />V <br /> <br />/ U~' /"' <br />9. Source of Legal Right-To-Enter / / <br />10. Type of Mine/Substance <br />11. General Location & Elevation <br />12. County <br />13. Acreage <br />14. Fee <br />3 ~7 fo = 7V-2 7 <br />~.T~~ tZS~ = 3 <br />15. Present Land Use / / r~~ <br />- <br />16. Surrounding Land Uses / ~ ~~ <br />~ <br />17. Proposed Future Use 1/ (/ ~;1dG~, <br />A=rrA) <br />nro <br />