Laserfiche WebLink
/~$ <br />LIMITED IMPACT (110) ~' ~l <br />SPECIAL 10-DAY (111) . <br />ITEM <br />APPL~CAT~DN CHEC<LIST IIIIIIIIIIIIIIIIIII <br />NAME ~~ ~ ~_~~- sss <br />~, ~ 1 ~. ,,, i , , ~~ <br />COMPLETE (FILED) DATE <br />COMPLETE ADEQUATE COMMENTS <br />Application Form: <br />1. Name of operation <br />/ <br />2. Name of applicant/operator l/ <br />3. Address r; phone, local ~ <br />4. Address E phone, general /,- <br />5. Person to contact <br />'/ <br />6. Surface owners /" <br />7. Mineral owners <br />L% / <br />8. Source of legal right-to-enter <br />~, <br />9. Type of mine/substance <br />i~ <br />10. General location 6 elevation <br />11. County <br />12. Acreage ~~ <br />13. fee <br />~° ~ , -~- <br />14. Present land use <br />IS• Proposed future use <br />16. Signature <br />L/~ <br />Maps and Exhibits <br />EXHIBIT A - Legal Description <br />l/ - ._ <br />EXHIBIT B - Mining Plan <br />EXNIBfT C - Map <br />EXH IBIT D - Wildlife, Water Resources, <br />Vegetation, Soils Information <br />