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14/77 III III IIIIII'lll III <br />• tED LAi:'D ?tECLe,.'?9TZO.I • <br />LL*~TED L`tPACT AidD S2°CZAL IO-DAY PrRi~!ZT APPLICATION C°--EC~.IST <br />ei?e ?to. tea- ~ Name L~1~. ~~~ Date of Filing (Completeness): <br />I?'~ ~ C0:`iPLETE 3DEQIIaTc CO~SEiTTS <br />9pplication Fora <br />1. Name of operation / <br />L// <br />2. Name of applicant/operator !/ <br />3. Address & phone (local offices) I ~/ <br />4. ?address 6 phone (general offices) l L/ <br />~. Person to contact I <br />5. Surface ovaers ~~ I <br /> <br />i <br />i <br /> <br />7. :fi.aeral a:aners I <br />~' I ` <br />I <br />B. Type of nine/substance I I I <br />9. General location ~ elevation I I <br />10. Countq ~~~ <br />I1. ncreage I <br />IZ. e'ee ' <br />I3. ?=ese::c land cse <br />I <br />- ~ <br /> <br />- - - ~ <br /> <br />- <br />1~+. ?reposed futu=e +se ; I <br />I5. Signature <br />_~ats and E.'ch'~T its <br />L. =-.aibit :~. - Legal description <br />Z. Ex.'~ibit B - ?Siaiag plan <br />I <br /> <br />i <br />3. smibit C - uap ~ <br />I I <br />~. 'cxbibit D - '+iiidlife, TJater Resources, <br />7egetation and Soils i.-t:cr- <br />matiDn <br /> <br />I <br />J. F°.'11b1t - R°C1dflaC10II plan ) <br />I ~ II <br />I I <br /> <br />