PERMFILE66797

• Permit No: M1977215
• IBM Index Class Name: Permit File
• Doc Name: REGULAR 112 PERMIT APPLICATION CHECKLIST
• Media Type: D
• Archive: No

4/77 III IIIIIIIIIIIIIIII
~LNED LAND RECLAPlATION •
Regular (112) Permit Anplication Checklist
File Ao.~~-2~ Name I,jKllc:r~, /Llvx,~4..'i,,. Date of Filing (Completeness):-
ITEi•1 COMPLETE ADEQUATE C0;`IIdENTS
Anplication Form
1. i4ame of operation
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2. :Tame of applicant ~ ~
3. Address ~ phone (local offices) (/ /
4. Address fi phone (gen'1. offices)
5. Person to contact ~ ~ t/
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5. Parent corporation (if any)
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7. Surface owners e/ ~I
3. 2Lineral owners I ~
9. Type of mine/substance /
.0. General location S elevation i / /
.1. County i v I /
.2. Acreage /
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.3. Fee

.4. Present land use ~
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.5. Surrounding land uses i /
.6. Proposed future use / '•
.7. Other mining permits ~ /
.8. Signature / /
.9. Prohibited Lands Statement (,/
'1aD5 6 Exhibits
1. Legal description
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2. Index man
3. Pre-mining S mining plan map
4. Paining elan - a) timetable
- b) depth b thickness of ore I
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