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i <br />7//'~+ ~ rPP~ 1CnT~("I C-EC:<LIST • III III III IIIIIII III <br />LIMITED IMPACT (110) x riAME Lee Do~oh ~ 7a ,, oirG _ FfLE s75-9 <br />SP£C1AL 10-DAY (Ill) ~. CDMPL~~E (FILED) Dort A riI 20, 1981 <br />I T"c.'1 <br />COMPLETE ADEQUATE COMME4T5 <br />Aoolication Fo n : <br />1. Name of operation ~ /~ <br />2. Yame of applicant/operator <br />3. Address s phone, lac.al <br />4. Address S phone, general I <br />! <br />j. Person to contact I <br />f ~ <br />6. Surface owners <br />7. Mineral owners <br />8. Source or legal right-to-enter <br />9. Type of mine/substan~;e ~ ( \ / <br />x <br />10. General location b elevation I ~ I <br />f x <br />11. Ccunty ^I I <br />1?. Acreage I S 6 ~ 9~ ~t7~f--_ e~,r <br />13• Foe I , / ~ <br />i~ ch e~ (r az `72 <br />14. Present land use <br />15. Prcposed future use I <br />i <br />16. Signature <br />`laps and Exhibits <br />EXHIBIT A - Legal Description _ <br />EX4IBIT 8 - Mining Plan <br />cX}i I B I T C - Map <br />J v <br />EXH I"o IT D - Uildtiife, t+at:er Resources, <br />Vegetation, Soils Information <br />L ~ I .. I l u ~, <br />