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7/i~ * .:r^^?LICi.TIO;! C:=cC:<LIST <br />LIMITED InPACT (110) ~, NAnE Siti M>~ti ~~~~ - r2 ~%fs F[L'c ~8~- <br />SPECIAL 10-DAY (1 1 I ) _ CDHPLETE (FILED) DATE Sep{-, 3~ r 5 € / <br />ITc*t COyPtETE ADE^~UATE COI1I!E`tT5 <br />Aoolication Forth: <br />1. Name of oeeration I ~ - <br />2. Yar,.e of applicant/operator. -. , <br />3. Address b phone, local <br />4. Address b phone, general I I - <br />j. Person to contact ?C I x ~ .. <br />6. Surface owners I - <br />7 -nineral owners I ~. _ - <br />S. Source of legal right-to-enter ~ I - ,' <br />3. Type of mine/substance <br />10. General location b elevation ~ .. <br />11. County ~ - - - <br />12. Acreage <br />_ <br />x <br />X ! <br />_ <br />13. Fee -• - - I -- I - - - I _. .. ..._._. ._ <br />14. Present land use ',._ _~ ` - _. _ <br />ij. Proposed future user - I <br />~ -- -~ I <br />~ 4-er•r:'^ r~r.~- I°-~. „yes <br />16, Signature <br />yeas and Exhibits <br />EXHIBIT a - Legal Description ~ uy gal .~' ~ '~ ~~ <br />EXHIBIT 8 - Mining Plan <br />EXH191T C - Map <br />~ <br />EXH !c IT D - 'di Idi~fe, '~atar aesou rc es, <br /> <br />Vegetation, Soils~Information <br />\ ~ I <br />x <br />~ tw._~d f..uov .O. W. .~.......+..l. <br />K~~ f,~ °4~ to/s•:~ y!e. {~,~,,,' ,, ,, <br />r.~ :, F<. <br />