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7/',a <br />LI`tIT_] I~",PACT (IlC) / <br />cPeC1AL 10-JAY ({11) <br />I ~ 'c.'1 <br /> <br /> <br />C:,:'P! c.iE (=1LcD) DATI: F~°G' ir//~'3 ~, <br />CCMPL=iE AC~QUATi? CCHP!~JTi <br />>cclica~icrt Fo r+: ~ <br />1. `Jame of operation ` ~' i X <br />2. Mar..e of applicant/opera car ~ ~ X i <br /> , <br />3. Address t: phone, local I I <br />I <br /> ~ X <br />I <br />4. Address ~ phcre, general ! ~ I <br />j. Person to contact I X I '~ <br />( I r <br />5. Surface owners ~ x <br />i. Hineral owners ` ~ I x I <br />S. icu r_e of le?al right-ta-enter I ~ I I <br />9. Type of minelsuhstance ( X ~ <br /> I <br />1C. General location b elevation I I <br /> X <br />` Y. <br />11. Caun:y I ' <br /> ~ X <br />f x <br />1 <br />1''. Acrezce <br /> X k <br />I;. ~e_ <br />` x I X <br />lli. ?resent IanC use <br /> X I x <br />Ij. ?rcaased furore use ~ ~ X I ~ <br />16. Sisna:ur_ <br />~` <br /> f y ! <br />Yaos and °_:c^ibits <br />X1iIi31T :, - Legal Cescription ~, y <br /> ~~/~~N c'`_~ <br />:XHl31T 8 - Rining Pian ~ <br />~ ~ <br />gXYl31T C - Yap I ` <br />I I <br />~ <br /> Y <br />/I <br />°-X'r. .o l- C -~Ji ldlife,=~~a :ar ?escurcas, \ <br />~ I <br />I <br />;`~etasa.cn; poi 1; In'cr-a;j.cn- _ <br />fC ~ . <br />