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7/78 APPLICATION CHECKLIST III I IIIII I IIIIII III <br />sss <br />REGULAR 112 APPLICATION NAME ryPYnnn~ lo..~ ~v FILE # 79 -a~6 <br />COMPLETE (FILED) DATE <br />---------------------------------------------------------------------------------------------- <br />ITEM <br />COMPLETE ADEQUATE COMMENTS <br />Application Form: <br />1. Name of operation <br />x <br />2. Name of applicant X <br />3. Address 6 phone, local <br />4. Address b phone, general X <br />5• Person to contact 1/ <br />/ <br />6. Parent Corporation, if any r, <br />x <br />7. Surface Owners <br />8. Mineral Owners <br />9• Source of Legal Right-to-Enter \/ <br />10. Type of Mine/Substance <br />I1. General Location E Elevation <br />N~.~r ~/~.~, t o,.. <br />12. County <br />x <br />13. Acreage <br />14. Fee <br />x <br />15. Present Land Use <br />16. Surrounding Land Uses <br />17. Proposed Future Use <br />18. Unpermitted Mining Operations ~ <br />19. Affected Lands <br />20. Signature <br />(over) <br />