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4177 - <br />~ILNED LAND RECLAMATION ~ III'II'll'II"II'II <br />Regular (112) Permit Application Checklist <br />~ File ?lo. ~8 qJ Name Co%. ~ imv~ C u.- /~Ic°C._)cf~ 0~rryDate of Filing (Completeness) <br />ITEi4 CaMPLETE <br />~.: ADEQUATE COrR1ENTS <br />Application Form <br />1. i4ame of operation <br /> <br />3/~~ <br /> <br />3/~~ <br />2. Vane of applicant 3 ~,~ <br />3. Address 6 phone (local offices} ~ <br />4. Address 6 phone (gen'1. offices) ~ ~~) ~ 13/ /7 <br />5. Person to contact ~ 3~~ 3~~ <br />6. Parent corporation (if any) <br />3/ <br />3 i <br />7. Surface owners 3 <br />3. Piineral owners i -~~~ ~ 3~~ ~ <br />9. Type of mine substance 3 ~ 3 ~ <br />0. General location b elevation ~ ~ ~,~ <br />1. County ~ 3~~7 I .3 i <br />1. Acreage <br />__ 3 ~ I ~ <br />__ <br />_ <br />3. Fee V <br />1 <br />~ ~' j <br />4. Present land use 3~ 3~~7 <br />5. Surrounding land uses ~ 3~~ 3 J~7 <br />6. Proposed future use 3 ~ 3 1 <br />7. Other mining permits ~ ~.~ 3 ~7 <br />8. Signature 3 ~ 7 3/~ ~ <br />9. Prohibited Lands Statement `~ ~ ~ /'~ ~ <br />'laps 6 Exhibits <br />1. Legal description <br />3 <br />~. Index map f <br />3. Pre-mining 6 mining plan map I ~ <br />~. Ptining plan - a) timetable I ~l~ <br />~ - b) depth 5 thickness of ore <br />I ~ I <br />~/I~ ~ <br />7 <br />7 <br />it <br />1 <br />7 <br />1 <br />1 <br />r <br />1 <br />h~dv <br />