Laserfiche WebLink
• • iii iiiiiiiiuiiiiii <br />DIVISION OF MINERALS AND GEOLOGY <br />Limited Impact 110(2) <br />Application Worksheet/Checklist <br />New App: ~ Amendment App: Conversion App: <br />Operator: nn ~(¢y~ Mine ID: Q~-~g'$ <br />Mine Name : l~(~ y) ~ r-~~ )~ P j ~~s3 I Submittal Date : I I I a (o IQ <br />APPLICATION FORM: <br />ITEMS 1 2 3 4 5 6 <br />COMPLETED <br />ITEMS 7 8 9 10 11 12 <br />COMPLETED <br />MAPS and EXHIBITS ADEQUACY COMMENTS <br />EXHIBIT A - LEGAL DESCRIPTION & LOCATION MAP <br />EXHIBIT B - SITE DESCRIPTION <br />a. Vegetation & Soils / <br />b. Critical Structures within 200 feet and offsite damage <br />c. Water Resources and Wildlife Statement (if provided) <br />