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<br />Regular 112 Application <br />~ , iii iiiiiiiiiiiiiii <br />MINED LAND RECLAMATION <br />Application Worksheet/Checklist <br />/1M~T/T I <br />Name Co/o. SGw.( +-Grao~( File No. _ o-iio <br />Complete Filed Date Oct i98S <br />ITEM <br />COhIPLETE ADEQUATE COMMENTS <br />Application Form: <br />1. Name of Operation x x <br />2. Name of Applicant/Operator <br />3. Address & Phone (Local) <br /> x <br />4. Address & Phone (General) <br /> <br />5. Person to Contact <br />6. Parent Corporation, if any <br /> x <br />7. Surface Owners <br /> x <br />8. Mineral Owners <br /> <br />9. Source of Legal Right-To-Enter r/ <br />J~ <br />10. Type of Mine/Substance ~ <br />11. General Location & Elevation X <br />12. County X <br /> <br />13. Acreage <br /> ,c x <br />14. Fee <br /> <br />15. Present Land Use <br />16. Surrounding Land Uses <br /> x x <br />17. Proposed Future Use <br /> ~ X <br /> <br />