PERMFILE110674

• Permit No: M1977193
• IBM Index Class Name: Permit File
• Doc Date: 9/9/1977
• Doc Name: LIMITED IMPACT AND SPECIAL 10 DAY PERMIT APPLCATION CHECKLIST
• Media Type: D
• Archive: No

MIIdED LAID RECLAMATION
~ LIMITED I1'iPIA--CTA""PID SPECIAL 10-DAY PEffi~IT APPLICATI0:1 CHECKLIST
File No. 99-/93 Name S~i.~r.[pa.iM Date of Filing (Completeness)
ITEM COMPLETE ADEQUATE COMMEidTS
Application Form
1. Name of operation
/
2. Name of applicant/operator /
3. Address & phone (local offices) /
4. Address & phone (general offices) /
5. Person to contact /'
6. Surface owners /
7. ifineral owners ~/
8. Type of mine/substance /'
9. General location & elevation i/
10. County ,/
11. Acreage
12. Fee ./
13. Present land use ,/
14. Proposed future use
15. Signature ,/~
Maps and Exhibits
1. Exhibit A - Legal description
/
2. Exhibit B - ~Sining plan ,/ 1~~5 worrC
3. Exhibit C - Map e ~ / S
rr "` c4
.,r.~ c+l:
4. Exhibit D - Wildlife,~Water Resources,
Vegetatiou~and Sails infor~
oration
~'~'~°
re.~~,
1~~ 4x~t'
~n'~- _
5. Exhibit E - Reclamation plan