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7/7? <br /> <br />L141T_0 InPACT (I10) ~ <br />SPECIAL 10-CAY (Ill) <br />------------------------------ <br />I ~ E'1 <br />.iST • <br />~~4rJ•n E- pr0+/„ -~M1f/~` ~1 ~Sp fr Gr~.+~l~ <br />N:.nE 444.r~c" r-iLE __-'8~a4 <br />COnPL..E (=ILED) DATA 8cre6er i. i9P~ <br />COnPLciE AOE7,UATE ConnE'JTS <br />Aoaticaticn =orm: I <br />( ! <br /> <br />1. `lame of operation I ~ ~ <br />I <br />I <br />2. `lar..e of applicant/opera tar <br /> X <br />3. Address E phone, local I ~ I ~ <br />w. :,ddress E phone, generai <br />j. Person Co contact _ ~ I <br />5. Surface owners <br /> X x I <br />i. `literal owners <br /> X <br />8. Source of legal right-ta-enter <br /> <br />9. Type of mine/substance I ~ I ` / <br />1C. General location E ele'iation I ~ I X <br />li. County <br />I ~ ~ ~ <br />;?, acreage <br />f <br /> ~ x <br />13. Pee <br />i ( x <br />1+. Present land use ~ ~ <br /> ~ <br />Ij. Procased Future use <br /> X <br />15. Signature ~ <br />I ~ I X <br />naps and Exhib~'s <br />_ <br />EnAl31T A - Legal Cescription v <br /> /~ x <br /> <br />E::HI31T 9 - ni i ing Pian I ~c,K;,,y ~Foce dPFn,~s' <br /> ~ /More eft, ;l . ~ ,.„¢tur,rG? <br />1 I <br />_XI1131T C - na F, I ~ ~ 5S SG[~JN, D<tui 5- <br />rn~,.•.y a.eo. <br />rK ore~ <br /> ~ ~ <br />~,~/R ~/ I <br />i I <br />Yri <br />T <br />- ' <br />E <br />l ° <br />' r~~ ,.cvd ~ s~f a~:vfrs~.,, <br />SI <br />a <br />. <br />D <br />d <br />e, <br />~:ater ~~scurces, <br />dd <br />'l <br />; <br />g~ <br />'~ <br />f~ ~ <br />` 3.>.:,.y of d;~..-S; J., S. so~_ <br /> <br />{ <br />~ <br />~ <br />t <br />e <br />e <br />ot, Sail; In?oraa_icn ~ rol- <br />°" <br />~II ~I~II~II~~~~~ ~I~ <br />999 <br />