Laserfiche WebLink
4,,7-_ _ ~ ~iriiiii~uiiiir~i • <br />t~LTPTED LA.`7D RECLAMATI02I <br />LIMITED I~MP~ACT :VVD SPECIAL 10-DAY PERcIIT APPLICATION CHECKLIST <br />vile No. ~~ Z~ Name 1/nle. ~$~~,r,-C,Ic-~(-~Date of Filing (Completeness):, <br />ITE:I COMPLETE ADEQIIATE COMbIE:~TS <br />Application Form <br />1. Name of operation <br /> <br />2. Name of applicant/operator ~ /~ <br />// <br />3. Address & phone (local offices) ~/~ <br />4. Address & phone (general offices} <br />5. Person to contact <br />5. Surface owners I ~ <br />'. ~Siaeral owners <br />8. Type of nine/substance <br />9. General location S elevation I ) l~ <br />/~' <br />I <br />I0. County I <br />11. Acreage <br />12. Fee <br />I3. Present land use I ~ <br />I ~ <br />I <br />14. Froposed future use I <br />I5. Signature <br />?Sans and Exhibits <br />1. Exhibit A - Legal description <br />Z. Exhibit B - t.ining plan f <br />3. Exhibit C - 2".av <br />4. Exhibit D - 'dildlife, ~vacer Resources, <br />7egetatioa and Soils infor- <br />mation <br /> <br />, <br /> <br />i <br />~. EXlllblt E - Reclamation plan ~ <br />