PERMFILE120908

• Permit No: M1995027
• IBM Index Class Name: Permit File
• Doc Date: 4/13/1995
• Doc Name: LIMITED IMPACT OPERATION 110 RECLAMATION PERMIT APPLICATION FORM
• Media Type: D
• Archive: No

-z-
PERMITTING CONTACT (if different from applicant/operator above)
Individual's Name:
Company Name:
Street:
City:
State: zip Code:
Area Code: Telephone:
INSPECTION CONTACT
Individual's Name:
Company Name:
Street:
City:
State: ~ Zip Code•
Area Code: Telephone:
CC: STATE OR FfiDERAL LANDOWNER (if anv)
Agency:
Street:
City:
State: Zip Code: ,
Area Code: Telephone:
CC: STATB OR FEDERAL LANDOWNER (if anv)
Agency:
Street:
City:
State: ~ zip Code• ,
Area Code: Telephone:
11. Primary uture (Poet-mining) land use (rheeJc one):
Cropland(CR) _ Paetureland(PL) General Agriculture(GA)
.~ ~ Raageland(RL) Forestrx(FR) = xildlife Habitat(WL)
Residential(RS) _ RecreatioII(RC) Industrial/Co®ercial(IC)
_ Developed Water Reeourcea (WR) = Solid Waste Disposal (WD)
12. Prisiazy resent laced uee (check one): '~
• Craplaad(CR) _ Paeturelaad(PL) General Agri lture(GA)
_ Ran9eland(RL) _ Porestrx(PR) xildlife Hob tat(xL)
Reaidential(RS) Recreatioa(R ) Industrial/ ommercial(IC)
_ Developed Water Reeourcea(FR) ~ ~ ?Siring (MN)
13. If this operation will uae designated chemicals, or wil result, or presently hoe
acid mine drainage - you canno use~thia~applicatioa~ rm. You must submit a either
~a 110d or 112d application form for Designated~ag Operations. Ice either case,
• you must list any acidic or toxic-forming materials, exposed or disturbed ae a
result of the mining operation, sad whether the operation will result_in or
presently has acid mine drainage:
Descriation of Conversion:
If you are converting an existing operation, provide a brief narrative describing the
proposed change(s).
Mane & Exhibit a:
. Submit two (2) complete, unbound copies of the following application exhibits: -.
~ 6.3.1 fiRFiIBIT A - Legal Description and Location Map
6.3.2 SXFiIBIT B - Site Description
6:3.3 BXHIBTT C - Mining Place •
6.3.4 BIIiIBTT D - Reclamation Play
6.3.5 BEtiIBTT H - Mapa ,
6.3.6 fiffiiIHIT F - Liet of Other Permits and Licensee Required ~
Title•