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~ III IIIIIIIIIIIII III ~ <br />999 <br />MINED LAND RECLAMATION <br />Application Worksheet/Checklist <br />Ua~~ <br />Regular 112 Application Name ~ ueb a E- f P~{-" File No. M _!TL-ol5 <br />Complete Filed Date Feb_ Io, ~9P6 <br />7 <br />ITEM <br />COMPLETE ADEQUATE COMMENTS <br />Application Form: <br />1. Name of Operation <br /> ~ X <br />2. Name of Applicant/Operator <br /> ~ }l <br />3. Address & Phone (Local) <br />4. Address & Phone (General) <br /> x <br />5. Person to Contact <br /> ~ ~ <br />6. Parent Corporation, if any <br /> .'G <br />7. Surface Owners <br /> „C <br />8. Mineral Owners <br />9. Source of Legal Right-To-Enter <br />10. Type of Mine/Substance <br /> x ~ <br />11. General Location & Elevation <br /> X <br />12. County <br /> <br />13. Acreage <br />14. Fee <br />~\ <br />15. Present Land Use X ~ <br />I~ <br />16. Surrounding Land Uses <br />17. Proposed Future Use <br />