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<br />MINED LPu~ID RECLAMATIOt7 <br />LIMITED IMPACT AND SPECIAL 10-DAY PERi~!IT APPLICATION CHECI~ZIST <br />File No. ~-,3~ Name ~M\~ ~CY~.~ .ar tc1L Date of Filing (Completeness) <br />ITEM COMPLETE ADEQUATE COMMENTS <br />Application Form <br />1.~ Name of operation <br />2. Name of applicant/operator v/ <br />3. Address 6 phone (local offices) / <br />4. Address & phone (general offices)' <br />5. Person to contact / <br />6. Surface ocmers <br />7. .Ltneral owners <br />8. Type of mine/substance ~/ <br />9. General location 6 elevation <br />10. county /~ <br />11. Acreage <br />12. r'ee I.~ <br />13. Present land use <br />14. Proposed future use <br />15. Signature <br />Maps and Exhibits <br />1. Exhibit A - Legal description / <br />~/ <br />~~ <br />2. Exhibit B - :•iining plan <br />3. Exhibit C - Map / ~a <br />4. Exhibit D - Wildlif Slater Resources, <br />Vegetatioet~aad Soils.ld~or- <br />oration <br />ao cpc <br />.s-~ <br />.~ <br />5. Exhibit E - Reclamation plan / <br />