PERMFILE114483

• Permit No: M1977325
• IBM Index Class Name: Permit File
• Doc Name: LIMITED IMPACT AND SPECIAL 10 DAY PERMIT APPLICATION CHECKLIST
• Media Type: D
• Archive: No

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MINED LAND RECLAMATIOt] ass
LIMITED It~fPACT A.vD SPECIAL 10-DAY PERMIT APPLICATION CHECKLIST
File No. ~ ~'.b2~Name. C'LS ^a~,~ Uc..r. ~'N~ Date of Filing (Completeness)
ITEM COyPLETE ADEQUATE COMMEidTS
Application Form
1. Name of operation
Z. Name of applicant/operator v~
3. Address & phone (local offices) /_
4. Address 6 phane (general offices) Lr
5. Person to contact V~
6. Surface ocmers ~. ~
7. :tiaeral owners /-
8. Type of mine/substance /
9. General location 6 elevation ,/"
10. County ~'
lI. Acreage 9 ~ / De
N~
12. Fee /
I3. Present land use
14. Proposed future use ~,/
15. Signature c/
Maps and Exhibits
1. Exhibit A - Legal description
/ -
~C/e5-~
- iivlpr/t~-~
Z. Ew'~ibit B - :fining plan ~~
3. Exhibit C - Maa ~/
4. Exhibit D - Wildlife, Slater Resource ,
Vegetationand Soils iafoi~
mation
L/
5. Exhibit E - Reclamation plan I /