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]/7$ III IIIIIIIIIIIII III • APPLICATION CHECiCL I ST <br />sss .2ouc~eJ ~ r~ ~c+ co,,..o.. <br />LlMllcv inrHUi ~~ iu~ ~ rIAMEf~'+ ~ FILE .- <br />SPECIAL 10-DAY (lil) _ COMPLETE (FILED) DATE ~y`"`~ <br />ITEM COMPLETE ADEQUATE COMMENTS <br />Application Form: <br />1. Name of operation <br /> <br />2. Name of applicant/operator / <br />~/ <br />3. Address E phone, local ~ <br />4. Address E phone, general f <br />5. Person to contact ~ v <br />6. Surface owners <br />]. Mineral owners <br />8. Source of legal right-to-enter f <br />9. Type of mine/substance <br />10. General location E elevation 1~ <br />11. County v <br />12. Acreage <br />13. Fee <br />14. Present land use <br />15. Proposed future use <br />16. Signature <br />Maps and Exhibits <br />EXHIBIT A - Legal Description -.~ <br />EXHIBIT B - Mining Plan <br />EXHIBIT C - Map <br />EXH IBIT D - Wildlife, Water Resources, <br />Vegetation, Soils Information <br />