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99 <br /> <br />~Permittee Name: <br />Permit No. <br />Operation Name: <br />Anniversary Date: <br />Total: <br />,~e«Pf o5`/Y <br />1f0`ite of Intent to COnti;lve Mining 09erati 0l'1S , <br />]~ Conetxv ction Ma t___es'~als Annue.l~oOYt t'~ ~ ~~~ z7~ <br />ce~.•,d. c,.y n~~~o pr34,:~+ RECE11r~n <br />i <br />M •'71 -isd <br />prcc~..k• zo, ,eq7 ' <br />$225.00 (Due on y~ur Anniversary DUwSiOno~hineraiexGumop, <br />i <br />1. a. Permitted acreage: 9.9 b. County where mine is located: ~o <br />2. Has this mine been granted TEMPORARY ~ ESSATION STATUS? YES <br /> Does this mine operate MORE or L$5S t <br />N lan 180 days per year? MORE LOSS <br />3, 11 <br />' <br />Does this mine have a phased reclamat!il <br />f or plan? YES NO <br />4. Total acres affected during the reporgl year:* Q <br /> <br />5. ~ Total acres reclaimed for the report y# ear:* G <br /> <br />6. Total number of acres in topsoil repl <br />' cement stage: ~ <br /> ~ <br /> ii <br />a. Average thickness Of topsoil repl~Y Ced: O <br /> <br />7. Total number of acres seeded: O <br /> a. List species seeded & seeding rat for report year on hack <br />8. Far non-phased operations provide datels extraction ceased: <br />9 <br />10 <br />a. Date reclamation began: ~~ <br />The type and approximate quantity of ilertilizers <br />conditioners used for the report year ,3* <br />Estimated total acres to be affecceo i~Z the next report year:* O <br />11. COhAfaNTS: <br />* Please show the location of the acreag~ for items Q - 6 on your map**. Indicate <br />the phases of the reclamation which have been ccj~leted, correlated with your timetable. <br />For phased operations show dates extraction ceasLd and dates reclamation began.. <br />•* :TOTE: If there have roc been any changes s'_nFFe the last annual report and you , <br />previously submitted a man which correctly depicks the current acreage ir. items 2 through <br />6, then a new map is unnecessary. However, thiB+JJ;must be stated above. <br />signature: LG~ /~. NC~C..._. I~~s"~ic}' ~~a4er ~ Date: 12-q-~j7 <br />Please type or print current contact name, mai'i~g address, and phone number below: <br />contact ATame: ^~_r ~ I~oc^~(cvs~.,,r•-l, ~' Phone: ~`L_ ) G~6 -3y~t <br />COmodr~y: ~ C ~O/a!e ( a ~ p`~'~' ~' FAX %O: L~_1G7~a•.3~ ~Z- <br />Address: 5115 CU[VHO UtrJ~_~d_ <br />Federal Tax ID ATn. or. Social Security No.: _g4=0 56 41 5/ ___~ <br />organic material or soil <br />iiEC- =-•~~ r9pIJ 1r.:2Et G3 F•L+ <br />