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lED La:1D RECLAM-4TI027 <br />~iililiiliiluiuiii <br />L4ffTED L`iPaCT AiIU SP°C~4L 10-DAY PSFL'?IT APPLICATIO:T C°..EChZIST <br />File No. ~-.5 ( :lame L : ~,_c-o ~~- C ~ ~ Date of Filing (Completeness) <br />_~ CO~LETE I aDEQUaT'c C0~"1`SEiTS <br />Aoolication Fot~ <br />L. Name of operation ~~~ <br />2. :lame of aonlicaat/operator ~~ <br />3. Address It phone (1oca1 offices) <br />4, address S phone (general offices) ~ <br />i <br />5. Person to contact I ~- ! ! <br /> <br />5. Surface ocaners <br />~~I i <br />I <br />7. 2fiaeral o•.aners L/- I <br />I <br />S. Type of ctiae/substance /- <br /> ~, <br />9. General location ~ elevation I I <br />L0. County I I <br />il. acreage I v~ <br />12. c'ee ~ <br />13. ?resent land use <br />I ~ <br />~ <br />I <br />1+. 2ro?osed futu=e use I I ~ <br />l5. Signature <br />t~aos and exh~its <br />1. S.caibit .~ -Legal desc_iptioa <br />Z. exhibit B - :'icing plan ~ <br />I <br />3. =-cai'cit C -wan I + i <br />':. Ess;bic D - Siildlife, Water ~esaurces, <br />7egetation and Sails 'n=or- (/ <br />cation <br />J. e.4P:~b 1L ° - 3eClaaaCioII elan I <br />