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4/77 � • <br /> MINED LA10 RECLAMATIOtd <br /> LIMITED IMPACT Ain SPECIAL 10-DAY PERifIT APPLICATION CHECKLIST l <br /> File No. 77-4-6-Aame Gt/Sv,V Date of Filing (Completeness) : <br /> ITEM COMPLETE ADEQUATE COMMENTS <br /> Application Form / - <br /> 1. Name of operation <br /> 2. Name of applicant/operator G�- <br /> 3. Address & phone (local offices) <br /> 4. Address 5 phone (general offices) <br /> 5. Person to contact <br /> 6. Surface owners <br /> 7. Mineral owners <br /> S. Type of mine/substance <br /> 9. General location 6 elevation <br /> 10. County <br /> 11. Acreage L� <br /> 12. Fee L� <br /> 13. Present land use <br /> 14. Proposed future use <br /> 15. Signature <br /> Maps and Exhibits <br /> 1. Exhibit A - Legal description �^ <br /> 2. Exhibit B - Mining plan <br /> 3. Exhibit C - Map <br /> 4. Exhibit D - Wildlife,i Water Resources, <br /> Vegetatioz?'and Soils in£or- <br /> mation <br /> 5. Exhibit E - Reclamation plan <br />