Laserfiche WebLink
4/77 <br />'~ -iii iiiiiiiiiiiu iii <br />MI~1ED LAi~ID RECLAMATION <br />~ ads >> <br />LIMITED IPIPACT P.ND SPECIAL 10-DAY PERi3IT APPLICATION CHECKLIST <br />File No.~o~~ Name~.~.(,'. ,~~ ~C~ Date of Filing (Completeness): <br />ITEM COMPLETE ADEQDATE COMPfENTS <br />Application Form <br />1. Flame of operation <br />2. Name of applicant/operator <br />3. Address 6 phone (local offices) / <br />4. Address & phone (general offices) ~/ <br />5. Person to contact ~/ <br />6. Surface owners ~' ~ <br />7. iiineral owners <br />8. Type of mine/substance <br />9. General location 6 elevation <br />10. County <br />11. Acreage / <br />/ <br />12. c'ee - ~yi <br />13. Present land use /' <br />14. Proposed future use <br />15. Signature <br />Maps and Exhibits <br />1. Exhibit A - Legal description <br />,/ <br />2. Exhibit B - :lining plan ~j !~>~•~,v.y <br />3. Exhibit C - Map / ~ <br />,/ <br />4. Exhibit D - Wildlife, Water Resources, <br />Vegetation and Soils infor- <br />mation <br /> <br />aG ~q t~ <br />, <br /> <br />~j !~ <br /> <br />~ y Sa~~c t~ •~%,,, <br />5. Exhibit E - Reclamation plan ~,Z( <br />~. <br />