PERMFILE121674

• Permit No: M1994096
• IBM Index Class Name: Permit File
• Doc Date: 11/21/1994
• Doc Name: LIMITED IMPACT OPERATION 110 RECLAMATION PERMIT APPLICATION FORM
• Media Type: D
• Archive: No

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(if different from applicant/operator above)
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INSPECTION CONTACT
Individual's Name:
Company Name
Street:
City:
State:
Area Code:
Agency:
Street:
City:
State:
Area Code:
Agency:
Street:
City:
State:
Area Code:
Title:
Telephone: ~'~ 5

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11. Primary future (Poet-mining) land use (check one):
y Cropland(CR) _ Paetureland(PL) General Agriculture(GA)
_ Rangeland(RL) _ Forestzx (FR) _
_ Wildlife Aabitat (WL)
Residential(RS) Recreation(RC) Industrial/Commercial(IC)
Developed Water Resources(WR) _ Solid Waste Dieposal(WD)
12. Primary present land use (check one):
~ Cropland(CR) _ Pastureland(PL) _ General Agriculture(GA)
_ Rangeland (RL) Forestry (FR) Wildlife Habitat (WL)
Residential(RS) _ Recreation(RC) _
Industrial/Commercial(IC)
_ Developed Water Resources (WR) _ Mining (MN)
:3. If this operation will use designated chemicals, or will result, or presently has
acid mine drainage - you cannot use this application form. You must submit a either
a 110d or 112d application form for Designated Mining Operations. In either case,
you must list any acidic or toxic-forming materials, exposed or disturbed as a
result of the mining operation, and whether the operation will result in or
presently has acid mine drainage : A/ ~~ :...~ p ~ ~ ~ ~ N / o .,, ~ /.. ,a ti .~~
Description of Conversion:
If you are converting an existing operation, provide a brief narrative describing the
proposed change(s).
MdD6 6 EXhi lte:
Submit two (2) cosip ete, unbound copies of the following application exhibits:
6.3.1 EXHIBIT A - Legal Description and Location Map
6.3.2 EXHIBIT 8 - Site Description