PERMFILE137324

• Permit No: M1982126
• IBM Index Class Name: Permit File
• Doc Name: MAPS & EXHIBITS
• Section_Exhibit Name: EXHIBIT A-P
• Media Type: D
• Archive: No

7/79
REGULAR 112 APPLICATION
ITEM
APPLICATION CHECKLIST
a
NAME ~va.,ilcv ~,a.,„~., ~ii:.~r( PF~E ~ P"~t/16
COMPLETE (FILED) DATE
COMPLETE ADEQUATE COMMENTS
Application Form: z
P-~t ~a
1. Name of operation
2. Name of applicant

3. Address E phone, local JC
4. Address 6 phone, general
~
5. Person Co contact
6. Parent Corporation, if any t
~ SC
7. Surface Owners

8. Mineral Owners I
9. Source of Legal Right-to-Enter
10. Type of Mine/Substance

ll. General Location b Elevation ~

12. County
13. Acreage
14. Fee
15. Present Land Use ~i
/ `
16. Surrounding Land Uses
17. Proposed Future Use ~ ' /
J~
19. Unpermittad hlining Operations
19. Affected Lands
20, Signature , > IrHnSe r%y,,,t4,e?
(over)