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7/7+ • .,P IIIIII'llllllllllll • <br />LIHIT_7 l~PACT (110) ~ ssa _ ~•vnP~_"f}da„r O:t ° F[Lc ~~'3-177 <br />SPEC I::L I 0-DAY ( I 1 1) ~ CJHP! ET-c (F I L°D) DATC Sejp1~ r~~ / 4~3 <br />ITE."1 COMPLY: AOEQVAT= COHME'1T5 <br />Aoclicaticn Forn: <br />1. Name of operation )c i ,L <br />2. Name of applicant/operator <br /> ~ K <br />3. Address s phene, local <br /> x ,~ <br />w. Address b phone, general I <br /> x K <br />5. Person to contact ~ I ~ I <br />6. Surface owners ` <br /> ~ ~ 4 <br />7. Mineral owners ~ <br /> ~ I ~G <br />3. Source of legal right-ta-enter I <br /> X <br />Type of mine/substanc: I I <br /> ~ X <br />10. General laeatien 6 elevation ~ ~ ~ X <br />11. Ccun:y I I <br /> I <br />>` i X I <br />13. Acreage I <br /> ~ x <br />Fee <br />I; I <br />. <br />I X ( I <br />14. Present land use { ~ <br /> ~ I I <br />15. 2raoosed fu :u re use <br /> ~ ~ <br />15. Sicnature I j <br /> ~ ~ <br />I <br />Moos and =xhibits _ - <br />EXHIBIT ,i - Legal Description x <br />E~.H131T 8 - Wining Plan x <br />~XH191T C - Map <br />~A ~ I <br />XH'oIT D -'.:i!d1i ~p 'pacer Peseurces, <br />c <br />~ I <br />„ ~ w4r~.-_ c+s.k AeJ• <br />je <br />ge:l <br />1 <br />` <br />? <br />'leaeta <br />!on, Seils <br />ln~cr^a-icn ~ 0 <br />- <br />~(-nf <br />' <br />T•ps.: <br />