PERMFILE101227

• Permit No: M1995012
• IBM Index Class Name: Permit File
• Doc Date: 2/13/1995
• Doc Name: LIMITED IMPACT OPERATION 110 RECLAMATION PERMIT APPLICATION FORM
• Media Type: D
• Archive: No

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PHRMITTING CONTACT' (if different from applicant/operator above)
Individual's Name: SAME -
Company Name:
Street:
City:
State: Zip Code:
Area Code: Telephone:
Individual's Name: N/A
Company Name:
Street:
City:
State: Zip Code:
Area Code: ~ Telephone:
CC: STATE OR FSDHRAL LANDOWNER of anv)
Agency: ~ N/A
Street:
City:
State: Zip Code:
Area Code: Telephone:
CC: STATH OR FSDHRAL LANDOWNER (if anv)
Agency: _~[LA
Street:
City:
State: Zip Code:
Area Code: Telephone:
11. Primary future (Poet-mining) land use (check one):
_ Crop~and(CR) _ Pastureland(PL) X General Agriculture(GA)
_ Ranyelaad(RL) Forestrx(FR) _ Wildlife Habitat(WL)
_ Resideatial(RS) _ Recreation(RC) Industrial/Commercial(IC)
_ Developed Water Reaourcee (WR) _ Solid Waste Disposal (WD)
12. Primary present land use (check one):
Cropland(CR) ~ Paetureland(PL) X General Agriculture(GA)
_ Raageland(RL) _ Forestzx(FR) _ Wildlife Habitat(WL)
_ Reerdential(RS) _ Recreatron(RC) Industrial/Coamiercial(IC)
_ Developed Water Resources (WR) _ Mining (MN)
13. if this operation will use designated chemicals, or will result, or presently hoe
acid mine drainage - you cannot uae this application form. You must submit a either
a 110d or 112d application fozm for Designated Mining Operations. In either case,
you moat list any acidic or toxic-forming materials, exposed or disturbed ae a
result of the mining operation, and whether the operation will result in or
presently has acid mine drainage: ,,.ir
Description of Conversion:
If you, are converting an existing operation, provide a brief narrative describing the
proposed change(s).
ifapa 6 Hxhibits•
Submit two (2) complete, unbound copies of the following application exhibits:
6.3.1 H7DiIBIT A - Legal Description and Location Map
6.3.2 HXEiIBIT B - Site Description
6.3.3 HXFiIBTT ~ C - Mining Plaa
6:3.4 SXFiIBIT D - Reclamation Plan
6.3.5 82HIBIT H - Maps
.-6:3:6 SSTiIBIT~F -~Liet of Other~Permits and Licenses Required
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