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7/78 IIIIIIIIIIIIIIIIIII/~ APPLICATION CHECKLIST g0_ <br />LIMIT sse NAME ter; ~~~•'~' ''.i FILE /1 3~ <br />SPECIAL 10-DAY ~ii~~ _ COMPLETE (FILED) DATE .~ - z ,5 -'~~ <br />---------------------------------------------------------------------------------------------- <br />ITEM <br />COMPLETE ADEQUATE CGMMENTS <br />Application Form: <br />1. Name of operation / / <br />2. Name of applicant/operator ~ / <br /> <br />3. Address E phone, local \ \ <br />4. Address b phone, general <br />i \ <br /> <br />i 1 <br />5. Person to contact ~ / <br />6. Surface owners / <br />7. Mineral owners <br />\ <br />8. Source of legal right-to-enter ~\ <br />9. Type of mine/substance ~ f <br /> i / <br />10. General location & elevation / <br />( <br />11. County ~ <br /> <br />12. Acreage / <br /> I <br />13. Fee , <br />14. Present land use / <br />` "~ <br />15• Proposed future use ~ <br /> / <br />M <br />s a ~i i lS i is ~ / v ~ L ~~ ~ <br />ap <br />i _ <br />EXHIBIT A - Legal Description t!l L~~ <br />EXHIBIT B - Mining Plan L~ ~~ <br />EXHIBIT C - Map (~ <br />EXH IBIT D - Wildlife, Water Resources,' <br />Vegetation, Soils Information <br />