PERMFILE106912

• Permit No: M1977141
• IBM Index Class Name: Permit File
• Doc Date: 9/8/1983
• Doc Name: APPLICATION CHECKLIST
• Media Type: D
• Archive: No

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7/7$ • APPLICATION CHECKLIST ~ yyy
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_ _ REGULAR 112 APPLICATION NAME ~ ~'O'~ f ~~/~~~ Y F I LE F` 77-/Y/
COMPLETE (FILED) DATE S~~T fl . / 9 4 S
ITFM COMPLETE ADEQUATE COMMENTS
Application Form:
1. Name of operation / /
v
2. Name of applicant ~/
3. Address b phone, local ~!
4. Address b phone, general /
5. Person to contact ~ I
i
6. Parent Corporation, if any ~
~'
7. Surface Owners ~
/ ~
i
$, Mineral Owners ~
9. Source of Legal Right-to-Enter I
/ I `
10. Type of Mine/Substance ~
11. General Location E Elevation
i
12. County
13. Acreage I
14. Fee
15. Present Land Use
16. Surrounding Land Uses ~
17, Proposed Future Use
I$. Unpermi*_ted Mining Operations /
19. Affected Lands
+
20. Signature /
(over)