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7/7$ III III III IIIIIIIIII L/~ APPLICATIO'! CHcCYLIST ~0-a,y6 <br />LIMITED InrNUi ~ i ivy Yoas Q+ .~ ~ NAME k3rcc~ Ro.s~N Roc{ S.~rc. FILE <br />SPECIAL 10-DAY (111) _ COMPLETE (FILED) DATE <br />ITEM COMPLETE ADEQUATE COMMENTS <br />Aoolication Form: <br />1. Name of operation <br />`~ <br />2. Name of applicant/operator ~~ <br />3. Address b phone, local <br />~~ <br />4, Address 8 phone, general ~~ <br />5. Person to contact <br />6. Surface owners v <br />7. Mineral owners °~ <br />8. Source of legal right-to-enter <br />9. Type of mine/substance / <br />10. General location b elevation <br />11. County / <br />12. Acreage ~~ <br />13. Fee ~ <br />14. Present land use ~~ <br />15. Proposed future use `~ <br />16. Signature ~ <br />Maps and Exhibits <br />EXHIBIT A - Legal Description <br />~ _ <br /> <br />EXHIBIT 8 - Mining Plan / <br />c/ <br />EXHIBIT C - Map <br />EXHIBIT D - Wildlife, Water Resources,'' <br />Vegetation !Soils Information `~ <br />