PERMFILE52726

• Permit No: M1979131
• IBM Index Class Name: Permit File
• Doc Name: APPLICATION CHECKLIST
• Section_Exhibit Name: EXHIBIT A
• Media Type: D
• Archive: No

7/78 •
LIMITED IMPACT (110)
SPECIAL 10-DAY (I11) _
ITEM
APPLICATION CH ECKL I ST III III III IIIIIII III
sss 79-
NAME ~ ~' -~~- F I LE $ /3 /
COMPLETE (FILED) DATE
------------------------------------------------------------
COMPLETE ADEQUATE COMMENTS
Application Form:~~ ~ /
1. Name of operation
2. Name of applicant/operator
3. Address & phone, local /
4. Address b phone, general
5. Person to contact
I
6. Surface owners
7. Mineral owners
8. Source of legal right-to-enter , /
v
9. Type of mine/substance , /
V
10. General location 6 elevation /
il. County /
V
12. Acreage /
1/
13. Fee ~J~ ~iL~L~~ ~J)S•00
14. Present land use ~ ~
15. Proposed future use
16. Signature
Maps and Exhibits
EXHIBIT A - Legal Description _
EXHIBIT B - Mining Pian
EXHIBIT L - Map (/
EXH IBIT D - Wildlife, Water Resources,
Vegetation, Soils Information D 5
'<~~' /~ ,~ C.., On/ ~ ~~
U~/~ /Ou/~