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4/77+ <br /> <br />• <br />~tED LA,YD RECI.d.UATION <br />LII'QTED L`lPACT ~yD SPECL4L 10-DAY PERi~!IT APPLICATIO:T C°--EC:O;.IST <br />File Va. -72 :tame L ~k~e 1~ Date of Fi1Lng (Completeness): <br />I'?'Er LETS ~DEQL'ATE CO.tiL~lE:TTS <br />A~nlication Fora <br />I. Name of operation <br />2. name of applicant/operator ~ G~ <br />3. Address b phone (1oca1 offices) I ~/ <br />4. Address b shone (general offices) ~ G,,i <br />5. Person to contact L/' <br />5. Surface ocmers ~/~i <br />i <br />I <br />7. :fiaeral o:aaers <br />S. Type of Dine/substance I/- <br />9. General locat:.oa S elevation ` <br />I ~-I I - <br />10. County ~~ <br />il. Acreage i v~ <br />I <br />IZ. r ee I r~/~ ~ I <br />li. P: eserc land use ~ ~/ I + <br />1+. ?:oposed future use I G~ I <br />I: Signature <br />:pans and E:chibics <br />I. Exaibit .~ - Legal description , / <br />v/'/ <br />Z. Exhibit B - 24iaing plan ~ ~ <br />3. %.-saibit C - yon <br />+. hY~ibit '~ - 'diidlife, Water Resources, <br />7egecation sad So'_ls ia:cr- <br />catian <br /> <br />I <br /> <br />I <br />S. _ ~'~ibit °_ - Reclanatioa plan ~ G// i I <br />