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4/77 <br /> •MI2TED LAND RECLAMATION • <br /> '< Regular (112) Permit Application Checklist <br /> File Na. �� � Name Sr'-O 5' PAJjMG Co. Date of Filing (Completeness) : <br /> ITE11 COMPLETE ADEQUATE COK ENTS <br /> Application Form / <br /> 1. Name of operation <br /> 2. :Tame of applicant ✓✓✓ <br /> 3. Address & phone (local offices) <br /> 4. Address & phone (gen' l. offices) <br /> S. Person to contact ✓ + <br /> 6. Parent corporation (if any) <br /> 7. Surface owners <br /> 3. Mineral owners <br /> 9. Type of mine/substance <br /> 10. General location & elevation <br /> 11. County <br /> 1 <br /> 12. Acreage <br /> 13. Fee <br /> 14. Present land use i <br /> 15. Surrounding land uses / <br /> 16. Proposed future use �/ <br /> 17 . Other mining permits <br /> 18. Signature <br /> I <br /> 19. Prohibited Lands Statement <br /> ;taps & Exhibits <br /> 1. Legal description V1, <br /> 2. Index mao V// <br /> 3. Pre-mining & mining plan map ✓ <br /> 4. Mining plan -(,a) timetable <br /> - b) depth & thickness of ore r p ✓ � , I <br /> body <br />