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j$ APPLICATION CHECKLiii <br /> J�U-IF» <br /> l IIJ <br /> 11TED IMPACT (110) NAME E IX E. f-S FILE <br /> _CIAL 10-DAY ( I11) _ COMPLETE (FILED) DATE Sr r &, .,bcr a ,'i <br /> _M COMPLETE ADEQUATE COMMENTS <br /> A ication Form: <br /> Name of operation <br /> Name of applicant/operator <br /> Address 6 phone, local <br /> Address E phone, general <br /> Person to contact <br /> Surface owners <br /> Mineral owners <br /> Source of legal right-to-enter <br /> Type of mine/substance <br /> General location b elevation <br /> County <br /> Acreage <br /> acrcu9e.f <br /> Fee <br /> Present land use <br /> Proposed future use * <br /> Signature <br /> s and Exhibits <br /> [BIT A - Legal Description <br /> [BIT B - Mining Plan <br /> IBIT C - Map <br /> J <br /> SIT D - Wildlife, Water Resources , <br /> Ve etetion , Soils Information <br />