_PERMIT FILE - M1983052

• Permit No: M1983052
• IBM Index Class Name: Permit File
• Doc Name: APPLICATION CHECKLIST
• Media Type: D
• Archive: No

7/78 + APPLICATION CHECKLIST999
III I(I'(IIIIIIII�II
REGULAR 112 APPLICATION NAMEL `� " FILE r Ik3" S�c
COMPLETE (FILED) DATE
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ITEM COMPLETE ADEQUATE COMMENTS
Aoolication Form:
1 . Name of operation X
i
2. Name of applicant x
3. Address b phone, local I X
i
4. Address & phone, general i
X I
5. Person to contact X
6. Parent Corporation, if any
X
7. Surface Owners
8, Mineral Owners X
9. Source of Legal Right-to-Enter i X
10. Type of Mine/Substance
X
11 . General Location E Elevation I
X '
12. County
13. Acreage
14. Fee
k
15. Present Land Use
16. Surrounding Land Uses X ! I
I I
17. Proposed Future Use
18. Unpermittad Mining Operations
x
19. Affected Lands I X
20. Signature
X I B�NOINb Fp4 /l1RRATHJN b0.Q.
(over)