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4/77} • IIIIIIIIIIIIIIIIIII . <br />' MPTED LAPID RECLAMATIOiI <br />LIMITED IMPACT A,~ID SPECL4I, 10-DAY PERialT APPLICATION C:iEC:Q.IST <br />rile No.~ ~ *tame ~o6i^s o,7 P f~~~: 47~ ~~ ~u Date of Filing (Completeness) :. <br />ITE'.I C0.`~LETE ADEQUATE COMME;ZTS <br />application Form <br />L. Name of operation <br />2. Name of applicant/operator <br />3. address S phone (local offices) <br />4. Address & phone (general offices} <br />5. Person to contact <br />5. Surface owners J I <br />i <br />7. Mineral owners / <br />V i <br />8. Type of mine/substance <br />9. General location E elevation <br />,~, <br />I >ncc~ w~~~ts ~ 1>> ~'~~ <br />fi <br /> . r. v,~ <br />MF .'T.~.~.~tui''S1 <br />I0. County <br />11. Acreage <br />I2. e'ee <br />I3. Present land use <br />14, Proposed future use ~ ~ <br /> <br />15. Signature <br />Maps and Exhibits nc~ J ' ^ ~~ <br /> <br />r ~. r~ <br />., <br />1. E.ehibit A -Legal description ~ <br />Z. Exhibit B -Mining plan / ` ~` ~ ~, ~, <br />r. P'.' <br />3. uhibit C - uap ~ .,~_~~ . , <br />4. Exhibit D - Tdildlife, Water Resources, <br />vegetation and Soils iafor- ~ <br />oration <br /> .,..,., nII . , l ~ S~ <br />5. E.4hibit E - Reciamatior. plan ~ i ~ rc~ J ~ ~c <br /> <br />