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4/77 <br />• PANED LAND P.ECLAPIATION ~ III IIIIIIIIIIIIIIII <br />Regular (112) Permit Application Checklist <br />F'1e `IoSG 7~-~~°Name ~t.~-f~-~~ CO""s'~~ Date of Filing (Completeness): g~3~7~ <br />ITEif COMPLETE ADEQUATE COMMENTS <br />Application Form <br />1. name of operation <br />2. Name of applicant (~ <br />3. Address E phone (local offices) <br />4. Address 6 phone (gen'1. offices) <br /> <br />5. Person to contact / <br />~ I/ <br />o. Parent corporation (if any) ~ <br /> <br />7. Surface owners / <br />v <br />3. Pfineral owners <br />i <br />9. Type of mine/substance <br />.0. General location ~ elevation <br />.1. County <br />.2. Acreage <br />.3. Fee ! <br />.4. Present land use ! ~ ~ <br />.5. Surrounding land uses <br />6. Proposed future use <br />7. Other mining permits <br />.8. Signature ~ <br />.9. Prohibited Lands Statement <br />:taps 6 Exhibits <br />1. Legal descriptior. <br />2. Index map <br />3. Pre-mining & mining plan map N ~ V ~~ ~~ <br />i <br />4. Pfining plan - a) timetable ~ ~ <br />- b) depth 6 thickness of ore ~ <br />~ j <br />! <br />. o~ <br />~~ <br />body <br />