PERMFILE123356

• Permit No: M1986047
• IBM Index Class Name: Permit File
• Doc Name: MINED LAND RECLAMATION APPLICATION WORKSHEET CHECKLIST
• Media Type: D
• Archive: No

III IIIIIIIIIIIII III
Limited Impact (110)
Special 10-Day (111)
ITEM
MINED LAND RECLAMATION
Application Worksheet/Checklist
Name
Complete Filed Date
File No.r~ g6-o~7
COMPLETE ADEQUATE COMMENTS
Application Form:
1. Name of Operation
2. Name of Applicant/Operator
3. Address & Phone (Local)
4. Address & Phone (General)
5. Person to Contact Wa°a^~$^""' e~ti
R~ S cl.a
6. Surface Owners X
7. Mineral Owners
8. Source of Legal Right-To-Enter
9. Type of MinelSuhstance ~/
10. General Location & Elevation X
11. County ~ /
/~
12. Acreage ~
13. Fee. ~, I~
/
V /'_ l~
~-0 ~
14. Present Land Use x
15. Proposed Future Use
16. Signature
a.-