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4/77 <br />~INED LAND RECLAMATION <br />ReRUlar (112) Permit Application Checklist <br />File'rio. 7-305 NameC~~~~e~CGJp LPZ~ Date of Filing (Completeness): <br />ITEi•S COMPLETE ADEQUATE COMMENTS <br />Application Form <br />1. flame of operation <br />2. ;lame of applicant <br />3. Address ~ phone (local offices) <br />4. Address 6 phone (gen'1. offices) ~ ! I <br />5. Person to contact <br />6. Parent corporation (if any) <br />7. Surface owners <br />B. Piineral owners <br />i <br />9. Type of mine/substance ' <br />0. General location 6 elevation ~ ~ <br /> <br />.i. County i i <br />I <br />1. Acreage <br />3. Fee <br /> <br />i <br />i <br />~ <br />.4. Present land use ~ 1 <br />~ <br />.~. Surrounding land uses ,, / <br />v <br />.6. Proposed future use " <br />~/ <br />.7. Other mining permits <br />.8. Signature <br />.9. Prohibited Lands Statement <br />':aps S Exhibits <br />1. Legal description <br />2. Index map <br />3. Pre-mining 5 mining plan map C/ <br />4. Piining plan - a) timetable <br />- b) depth b thickness of ore <br />ooay <br />