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4/77 <br />* MINED LARD RECLA4fATION <br />~ Regular (112) Permit Application Checklist <br />i cif # / <br />File 1do. ?7-'~ Name S-~~e,, ~INC ~~ano~ u~c( ~k.~c~Date of Filing (Completeness): <br />ITE'if COMPLETE ADEQUATE COZ•4fENTS <br />Application Form <br />1. Name of operation <br />2. Name of applicant /~ <br /> <br />3. Address 6 phone (local offices) / <br />(/ <br />4. Address b phone (gen'1. offices) <br />5. Person to contact ~ <br />6. Parent corporation (if any) 1 ~ ~~' ~ <br />7. Surface owners <br />3. tiineral owners <br />i <br />9. Type of mine/substance / <br />.0. General location S elevation ~ <br />.1. County ~ / I I <br />.2. Acreage <br />.3. Fee ~ I ~ <br /> <br />4. Present land use ~ ~ i <br />~ <br />.5. Surrounding land uses ~ <br />6. Proposed future use <br />7. Other mining permits <br />.8. Signature <br /> <br />.9. Prohibited Lands Statement Ni <br />:taps & Exhibits <br />1. Legal description <br />/ <br />2. Index map (l <br />3. Pre-mining S mining plan map <br />4. Pfining plan - a) timetable <br />- b) depth 6 thickness of ore <br />I I <br />DDQy <br />