PERMFILE107740

• Permit No: M1978102
• IBM Index Class Name: Permit File
• Doc Name: LIMITED IMPACT AND SPECIAL 10 DAY PERMIT APPLICATION CHECKLIST
• Media Type: D
• Archive: No

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MIMED Llu\TD RECLAMATIOt7 sss
LIMITED IPiPACT P,ND SPECIAL 10-DAY PERi~:IT APPLICATION CHECKLIST
File No. 78 /~' Names'/~iT~p,Q}' ~j1~ ~C /~. j~/. Date of Filing (Completeness) :,
ITEM COMPLETE ADEQUATE COM4tEiTfS
Application Form
1. Name of operation
1
2. Name of applicant/operator ~/~
3. Address 6 phone (local offices) ~ /
4. Address S phone (general offices)
5. Person to contact 3 ~ 3
5. Surface ocaners 3~3 I
7. Piineral owners ~ 3
8. Type of mine/substance 3/ 3 ~
9. General location 6 elevation 3 /
I0. county 1
11. Acreage 3 / '
I2. Fee 3
13. Present land use 3 ~3 ~
14. Proposed future use 3 ~.3~
15. Signature 3
Maps and Exhibits
1. Exhibit A - Legal description
2. Exhibit B - :fining plan 3/
3. Exhibit C - Map 3 ~3 ~
4. Exhibit D - Wildlife, Water Resources,
Vegetation and Soils iafor-
motion
~/3 )
5. Exhibit E - Reclamation plan 3/3 1