Laserfiche WebLink
MINED III IIIIIIIIIIIIIIII <br />Appl icatio~~ nyi n~ncC1./ l,nCl.K I15t li <br />Reoular 112 Application Name .}uu(;ez6Wi/ni File No. -`o~OL'z <br />Complete Filed Date <br />ITEM COMPLETE ADEQUATE ~ COMMENTS <br />Application Form: <br />1. Name of Operation <br /> <br />2. Name of Applicant/Operator i <br />3. Address & Phone (Local) J <br />/~' ~ <br />4. Address & Phone (General) <br />5. Person to Contact ,L <br />6. Parent Corporation, if any <br />7. Surface Owners J <br />/ <br />8. Mineral Owners J <br />/~ ii <br />9. Source of Legal Right-To-Enter <br />10. Type of Mine/Substance I <br />11. General Location & Elevation <br />12. County ,( <br />/~ <br />13. Acreage J <br />/' <br />14. Fee ~ ~ `~ C,~ <br />15. Present Land Use v <br />16. Surrounding Land Uses (~ <br />17. Proposed Future Use ~ <br />