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7/78 • APPLICATION CHi:C,<LIST <br />s~ ~,' - <br />LIMITED IMPACT (110) v NAME ~~ - • FILE ~.~-~~ <br />SPECIAL 10-DAY (I 11) _ ---------COMPLETE-(FILED)-DATE- - ~ _ ! _i__~~ <br />ITEM ;,,f~ - COMPLETE ADEQUATE COMMENTS <br />i - - <br />Application <br />1. Name of Form: <br />operation <br />2. Name of applicant/operator <br />3. Address E phone, local <br />4. Address E phone, general <br />5. Person to a~ntact ` <br />6. Surface owners <br />7. Mineral owners <br />8. Source of legal right-to-enter 1 4 <br />4 <br />9. Type of mine;/substance ~ <br />10. General location b elevation I <br />11. County <br />12. Acreage <br />13. Fee <br />14. Present land use <br />15. Proposed future use <br />16. Signature <br /> <br />Maps and Exhibits <br />EXHIBIT A - Legal Description ~ ~ <br />- .,~ <br />EXHIBIT 8 - Mining Plan ~ . <br />EXHIBIT C - Map <br />EXH 131T D - Wildlife/Wa~er Resources, <br />Vegetation, Soils Information <br />