Laserfiche WebLink
<br />Limited Im act_j110 <br />Special 10-Day (111) <br />File No.~~~-/D~ <br />ITEM <br />• II~ I~II~~I~~II • <br />sss II'll <br />MINED LAND RECLAMATION <br />Application Worksheet/Checklist <br />Name /Yl, .:~c..V,,a~Q,.Q.c,r~ CA <br />Complete Filed Date _ _ <br />COMPLETE ADEQUATE COMMENTS <br />Application Form: <br />1. Name of Operation <br />2. Name of Applicant/Operator ~i ,~ <br />3. Address & Phone (Local) _~- <br />4. Address & Phone (General) x <br />5. Person to Contact ~ X <br />6. Surface Owners ~/ X <br />7. Mineral Owners ~ ~ <br />8. Source of Legal Right-To-Enter X <br />9. Type of (Nine/Substance X x <br />10. General Location & Elevation ~ ~ <br />11. County ~ ~ <br />12. Acreage ~ ~ 3.8b au,~~ 8, 3.0~, <br />13. Fee X X <br />14. Present land Use ~i X <br />15. Proposed future Use <br />16. Signatures <br />