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III IIIIIIIIIIIII III <br />7/78 • APPLICi.T!CN C:=EC:CLIST • <br />~7 <br />LIMITED IMPACT (110) ~, NAHE`~'~u ~~ ~~"'~''^'~~ '/'`"~--L'!~- FILE S ~-1`3S <br />SPECIAL 10-OAY (I 11) _ CDMPL~,E ('TILED) DATE .;/ (!ic,.w~i7-"31.19.5/ __ _ <br />IT-c`1 COMPLETE ADE^,,UATE COMME"1T5 <br />Aoolicaticn Form: <br />1 . Name of operat i on <br />/ <br />rl ~ . ~ ~ ~~/~,~,~. <br />2. Nart:e of applicant/operator / <br />3. Address E phone, local / <br />t I <br />4. Address b phone, general / <br />/ I <br />5. P_rson to contact ~ <br />6. Surface owners <br />i/ <br />_ <br />7. Mineral owners ~ I I <br />8. Source of legal right-co-enter I , I . <br />9. Type of mine/substance I / I <br />1 I , C ,~~~ ~~.,Ii,;-.~ <br />V~ ~ <br />10. General location E elevation <br />11. County ,/ I <br />12. Acreage ~ I I <br />13. Pee / I I <br />14. Present land use <br />IS• Proposed future use / I <br />v <br />i <br />16. Signature / <br />1 <br />Moos and Exhibits <br />EXHIBIT A - Legal Description <br />/ - <br />EXNI9IT 8 - Mining Pian ~, <br />-cXHI81T C - Map <br />EXH .BIT D - 'di ldl ife, 'dater ilescurces, <br />Vegetation, Soils Information ~, <br />