PERMFILE115752

• Permit No: M1986165
• IBM Index Class Name: Permit File
• Doc Date: 12/29/1986
• Doc Name: LIMITED IMPACT 110 AND SPECIAL 10 DAY PERMIT APPLICATION FORM
• Media Type: D
• Archive: No

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MINED LAND WILDLIFE STATEMENT/EVALUATION (Revised)
for limited impact and select regular mine applications
The following information pertaining to wildlife is provided for vse by Mined Land
Reclamation Board in their consideration of a mining permit for:
Name/Type and Location of Mine (Legal)
Wildlife Species list:
Endangered/critical species/impacted:
Critical habitats/vegetative communities impacted:
Assessment of impact:

Mine Reclamation recommendations (include key species/habitats for which restoration
is designed).
Prepared By: Date:
Submitted By: Date;
This statement is void if not processed within 1 year.
Thi= ~-~alysis does not constitut^ "~ of appllcntion.