PERMFILE123474

• Permit No: M1994103
• IBM Index Class Name: Permit File
• Doc Date: 6/21/1995
• Doc Name: LIMITED IMPACT OPERATION 110 RECLAMATION PERMIT APPLICATION FORM
• Media Type: D
• Archive: No

city:
State:
Area Code:
PERMITTING CONTACT (if
Individual's Name:
Company Name
Street:
City:
State:
Area Code:
INSPECTION CONTACT
Individual's Name:
Company Name:
Street:
City:
State:
Area Code:

-s-
~G~ Zip Code: _(
_ Telephone:
from applicant/operator above)
Title: ~i^ad.
Zip Code:
Telephone: - ~
11. Primary future (Post-mining) lead use (chec)c one):
Cropland(CR) _ Pastureland(PL) _ General Agriculture(GA)
~Z,Rangeland(RL) _ Forestry (FR) _ Wildlife Habitat {WL)
_ Residential(RS) Re creation(RC) Industrial/Commercial(ZC)
_ Developed water Resources (WR) _ Solid Waste Disposal (WD)
1?. Primary present land use (check one):
Cropland (CR) Pastureland (PL) _ General Agriculture (GA)
_ Rangelaad(RL) _ Forestry(FR) _ Wildlife Habitat(WL)
_ Residential(RS) Recreation(RC) _ Industrial/COmmercial(IC)
_ Developed water Resources(WR) _ Mining(MN,`)-~J~ I_
13. If this ~~-SYvc~~ 6vro~V~' ~ P1 ~-
operation will use designated chemicals, or will result, or presently has
acid mine drainage - you cannot use this application fozm. 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 thgg operation will result in or
presently has acid mine drainage: _~/ fe
Description of Conversion:
if you are converting an existing operation, provide a brief narrative describing the
proposed change(s).
Mans ~ Exhibits:
Submit txo (2) complete, unbound copies of the following application exhibits:
6.3.1 fi70iIBIT A - Legal Description and Location Map
6.3.2 &74iIBZT 8 - Site Description
Agency: /l,/T/.4
Street:
City:
State: Zip Code:
Area Code: Telephone: