PERMFILE61218

• Permit No: M1977197
• IBM Index Class Name: Permit File
• Doc Name: APPLICTION CHECKLIST
• Media Type: D
• Archive: No

7/i8
LIMITEp IMPACT (110}
SPECIAL 10-DAY (111)
APPL I CAT I OtJ
F I L E '7>-~v,
--------------------------------------------------------------------------------------------
tTEM COMPLETE ADEQUATE COMMENTS
Application Form:
1. Name of operation
v
2. Name of applicant/operator ~ /
v
3. Address 6 phone, local
4. Address E phone, general v
5. Person to contact
6. Surface owners v
7. Mineral owners v
8. Source of legal right-to-enter //
G./-
9. Type of mine/substance
10. General location b elevation
Il. County (~'
12. Acreage (/
13. fee ~
14. Present land use / /
V
15- Proposed future use
15. Signa~ure
Maps and Exhibits
EXHIBIT A - Legal Description
EXHIBIT B - Mining Plan
EXHIBIT C - Map ~'
EXH IBIT D - Wildlife, Water Resources,
Vegetation, Soils Information V

cHEC~LISr IIIII~IIIII~IIIIIII
NAME r1 ar.t /~1~ .QGd- i 1~'1~~ ~ i,d ~-,-
COMPLETE (FILED) DATE