PERMFILE125966

• Permit No: M1978305
• IBM Index Class Name: Permit File
• Doc Name: APPLICATION CHECKLIST
• Media Type: D
• Archive: No

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APPLICATION CHECKLIST
III IIIIIIIIIIIIIIII
999
LIMITED IMPACT (110) !/ NAME~~•'~%-' FILE ,#
SPECIAL 10-DAY (111) _ COMPLETE (FILED) DATE
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ITEM COMPLETE ADEQUATE COMMENTS
Application Form:
1. Name of operation
2. Name of applicant/operator
3. Address 6 phone, local v--
4. Address 6 phone, general L/
5. Person to contact v'
I
6. Surface owners ~/l ~
7. Mineral owners
8. Source of legal right-to-enter _ _
9. Type of mine/substance /~
10. General location & elevation ~
L% -~
11 . County ~ - -"
12. Acreage
,r ,
13. Fee ~~
14. Present land use
15. Proposed future use iii'
16. Signature
Maps and Exhibits
EXHIBIT A - Legal Description ~
- ~ ~ _
EXHIBIT B - Mining Plan ~/
EXHIBIT C - Map
EXH IBIT D - Wildlife; Water Resource s
Vegetation~Soils Information