PERMFILE112186

• Permit No: M1979205
• IBM Index Class Name: Permit File
• Doc Name: LIMITED IMPACT & SPECIAL 10-DAY PERMIT APPLICATION CHECKLIST
• Media Type: D
• Archive: No

4/77 ~ • IIIlIIIIIIII~~IIIII
999
MItdED LAND RECLAPIATI02]
LIMITED IMPACT AIdD SPECIAL 10-DAY PERilIT APPLICATION CHECKLIST
File No. 7~ /~OName ~fj~,"~,+~~jiy, jJ9~/~, /p ,~j,Spate of Filing (Completeness)
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ITEM COMPLETE ADEQUATE CO*AfE!dT5
Application Form
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1. tame of operation G/~~ ,~
~~ ~~ G~ F~ , .. ,- :_ ,,7
2. Name of applicant/operator , ;~
G ~ , ~

3. Address ~ phone (local offices) ~/~ -
.
~ , _
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4. Address & phone (general offices) ^,
G
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5. Person to contact G .? ~ ^
6. Surface owners ~/~
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7. Ptineral owners /!3 L~
~" ~ .- ~

3. Type of mine/substance
~ /~
~% ? ~ c
~', ~
C~
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9. General location & elevation / _ ~ ,
O '~ C~
10. County ~~~'G'
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/:`- - ~ Rf/CL/~
II. Acreage ~ U ,~ Z' ~

12. Fee ~j ~ ~
13. Present land use ~/-~ ~~ T c
14. Proposed future use / /. ~
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15. Signature (j/ ,^ ~ "~ '
Maps and Exhibits

1. Exhibit A - Legal description /
(J /7 ~'
__ •
2. Exhibit B - Paining plan O -~ ~ ~/ 2
3. Exhibit C - Map ~ ~ Z
4. Exhibit D - Wildlife; ter Resources,'
Vegetat3~and Soils infor- // ~ / v
oration ~G,
C~
5. Exhibit E - Reclamation plan 6 ~3 0