Laserfiche WebLink
4/77 ~ III III III IIIIIIIIII <br />sss <br />PfII~IED LAPID RECLAMATION <br />2-G-78 ~~~ <br />v/ LIgMITED IrD?ACT AND SPECIAL 10-DAY PERMIT APPLICATION CHECKLIST <br />File No./ ~~~/flame~/o~//SE/ ~i~/9!//~/K Date of Filing (Completeness): <br />ITE:i COMPLETE ADEQUATE COMME<dTS <br />Application Form <br />1. Name of operation ~/~JlJ~~ ,EJ/K/E. <br />2. Name of applicant/operator v <br />3. Address 6 phone (local offices) (~ <br />4. Address b phone (general offices) ~/ <br />5. Person to contact ~ <br />6. Surface owners ~~ <br />7. Pfiaeral owaers ~/ <br />8. Type of mine/substance <br />~/~ ~ f/ ~• V•~:• , <br />9. General location & elevation ~~ <br />10. county L/ <br />11. Acreage L/' 9~ ~j <br />12. Fee !~ L--. ~ ys-..' - ~j,~~ <br />13. Present land use L/~ L~ <br />14. Proposed future use ~- L/ <br />15. Signature L~ (~,/' <br /> <br />Maps aad Exhibits <br />1. Exhibit A - Legal description <br /> <br />/~/" <br /> <br />~ ,~ ~ ~ <br /> <br />~~ <br />2. Exhibit B - :Sining plan (/~ (/~ <br />3. Exhibit C - Map ~~ ~~~- <br />4. Exhibit D - Wildlife, Water Resourcesl~ <br />Vegetationand Soils ~r- <br />mation <br /> <br />5 9N=D/ v /X-JAL: ~. <br />. Exhibit E - Reclamation plan <br />