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7/78 APPLICATION CHECKLIST Flo <br /> LIMITED IMPACT (110) �� U NAME/RDZ��'h—C'55 CO/�P FILE #171 <br /> SPECIAL 10-DAY (111) _ COMPLETE (FILED) DATE /9UG, g9/I.r�O <br /> ---------------------------------------------------------------------------------------------- <br /> ITEM / / D�vE LCvEL COMPLETE ADEQUATE COMMENTS <br /> Application Form: <br /> 1 . Name of operation <br /> 2. Name of applicant/operator \ <br /> 3• Address & phone, local 1 <br /> 4. Address & phone , general <br /> 5. Person to contact <br /> 6. Surface owners \ <br /> 7. Mineral owners 1 `\ <br /> 8. Source of legal right-to-enter \ / <br /> 9. Type of mine/substance <br /> 10. General location & elevation <br /> 11 . County / <br /> 12. Acreage I <br /> 13. Fee JI \ <br /> 14. Present land use �\ <br /> 15• Proposed future use <br /> 16. Signature <br /> % <br /> Maps and Exhibits - <br /> EXHIBIT A - Legal Description L-� <br /> EXHIBIT B - Mining Plan (� <br /> EXHIBIT C - Map <br /> EXH BIT D - Wildlife,. Water Resources , <br /> Vegetation , Soils Information <br />