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` ~ ll <br />4/77} ~ • ~II ~I'll'111~'1~'ll <br />MLYED L?u~1D RECLAPfATION <br />LIMITED L*D?ACT AND SPECIAL 10-DAY PERialT APPLICATION CHECKI:IST <br />File No. 79+S6B' Name 5~...~,.~ Cwa~ Date of Filing (Completene:as) <br />ITE.`4 CO~LETE ADEQUATE CO:AD dT5 <br />Application Form <br />1. Piame of operation <br />,r.-E <br />2. Name of applicant/operator / <br />3. Address & phone (local offices) <br /> <br />4, address S phone (oeaeral offices) ,~ <br />5, Person to contact ~ <br />5. Surface o~.mers ~ <br /> / <br /> <br />7. ,Mineral owners <br />~/ I <br />! <br />1ll <br />8. Type of mine/substance / <br />9. General location 5 elevatio¢ ~ f <br />f <br />I0. County ,/ <br />11. Acreage I '~ <br />12. : ee ~/I <br />13. Present land use ~ <br /> t <br />I4, Proposed future use I ~ <br /> I '~ ~' <br />15. Signature ,/ <br />Naps and E::hibits <br />1. E,ehibit A -Legal descriptio¢ 1/ <br />Z. Ex'~ibi*_ B - 2Siaiag plan <br />t C - i1aD <br />3 <br />E;Cf1iJl [ <br />~ <br />. <br />. I / ~~ ti <br />1 <br />~. F.ahl3it D - Slildlife%er R sources + <br />7egetatioa and oils iafor- ~ek d - --~s•' ~{ -_ <br />motion I <br />5. =xh:bit E -Reclamation plan ~ ~o+.e IAe~' °~Y' v~~ SGS - <br /> 5 - <br /> <br />