PERMFILE103355

• Permit No: M1991071
• IBM Index Class Name: Permit File
• Doc Date: 6/24/1991
• Doc Name: APPLICATION WORKSHEET/CHECKLIST
• Media Type: D
• Archive: No

~°~3
-•- M~ LAND WILDLIFE QUESTIONNAIRE
For Limited Impact and Select Regular Mine Applications
1. Name of Company/Mine: /C/T (.dYfe~t~ /~~0~.~'y ~~ /COdpjl p
2. Name/Address/Phone of Contact Person: ~ru t"~P~CI-SBrt, 8/oL ~4 D~~r+1 i~+^
---~ r--~
(p X3080 ~ ~, )J 419) 54(; - ~.I I ~ •
3. Location of Mine: K,f ~~SD+c~• 785, lZ4SW ~G /~ ~~Iq•, ~~4.
(County, Township, Range, Section,,tQQo nearest quarter quarter; Exhibit A-MLR appl.)
4. Nearest Town/General Location: 6/Q//'i+~-L__
5. Land Ownership (Circle)~- Priva 2. BLM 3. USFS 4. Other
6. Present Land Use: ~I.o~,G_•/d-K-~
7. Proposed Final Land Use: /id+-tr~,C_.~~
8. Type of Operation: Surfa 2. Undergrou'n'd, n .
9. Afinerals being mined: ~jFl/'t-ll~d7L~. ~~--C
--~'
10. Number and Description of/S}urface Acres Disturbed by Mining/not including roads
(Exhibit 1}-PII.R) : ~~ -/ dGi,lJ
11. Miles of roads to be constructed
12. Life of Dfine (years):
13. Description of Operation and Reclamation -- Additional sheets may be attached
(Exhibits B b E-MLR) .
14. 'Please enclose Maps of Project Operation, Disturbance Areas and Reclamation (Exhibit
C.) This will exp~ to pro ssing. Your cooperation is appreciated.
15, Prepared by: V` ~C~-w,~ Date: ~-~'q~
Parr, 1 of 2
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