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4/77 <br /> MINED LAND RF.rT ^*"--IN <br /> 'I <br /> L. <br /> (112) FIIIIOIICheckist 999 <br /> File -.No. 7 7-41g3 Name Date of Filing (Completeness) : <br /> ITE1,1 COMPLETE ADEQUATE COMMENTS <br /> Application Form <br /> 1. dame of operation <br /> 2. Name of applicant <br /> 3. Address & phone (local offices) <br /> 4. Address & phone (gen'l. offices) <br /> 5. Person to contact <br /> 6. Parent corporation (if any) <br /> 7. Surface owners <br /> 8. Mineral owners <br /> i <br /> 9. Type of mine/substance 1 <br /> LO. General location & elevation <br /> Ll. County Y i <br /> L2. Acreage <br /> L3. Fee i <br /> I <br /> L4. Present land use i <br /> L5. Surrounding land uses <br /> L6. Proposed future use <br /> I <br /> L7. Other mining permits <br /> L8. Signature <br /> L9. Prohibited Lands Statement <br /> Haps & Exhibits <br /> 1. Legal description <br /> 2. Index map �.- <br /> 3. Pre-mining & mining plan map <br /> I <br /> 4. Mining plan - a) timetable <br /> - b) depth & thickness of ore <br /> i , <br /> body <br />