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jS APPLICATION! CHcC(.LiSi ~~ <br />MITED IMPACT (110) ~ <br />ECIAL 10-DA`! (lll) _, • NAME EI I <br />COMPLETE 'v to ~u4.,1 <br />(FILED) DATE Y P,'lll llllll!IIIIII III~'_~9s_ <br />Se~fo..,b~• a_'! 1980'"`'"'•~ <br />r <br />EM COMPLETE ADEQUATE COMMENTS , <br />L t. ) j <br />olica[ion Form: <br />Name of operation <br />flame of applicant/operator <br />Address E phone, local <br />Address E phone, general <br />Person to contact <br />Surface owners <br />Mineral owners <br />Source of legal right-to-enter <br />Type of mine/substance <br />. General location b elevation <br />. County <br />Acreage ~V «v( ~ ~ d ; ~: d u u ~ <br />4cr~vgCS <br />. Fee <br />. Present land use <br />. Proposed future use <br />. Signature <br />~s and Exhibits <br />iIBIT A - Legal Description <br />iIBIT 8 - Mining Pian <br />iI81T C - Map <br />J ~ <br />i bIT D - Wildlife, Water Resources, <br />Ve eta~ion, Soils Information <br />` <br />x <br />