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7/7$ III III III IIIIIII III ~ APPLICATION CHECKLIST • <br />sss o,_ <br />LIMITED IrtrAUl lllul _ NAME ~ ILc ~ R_ <br />SPECIAL 10-DAY (111) _ COMP E E (FILED DATE <br />---------------------------------------------------------------------------------------------- <br />ITEM <br />COMPLETE ADEQUATE COMMENTS <br />Application Form: <br />1. Name of operation <br />~~ <br />2. Name of applicant/operator ~. <br />3. Address & phone, local <br />4. Address E phone, general v <br />5. Person to contact li <br />6. Surface owners (i <br />7. Mineral owners ~ <br />$. Source of legal right-to-enter ~~ <br />9. Type of mine/substance ~/ <br />10. General location E elevation ~_ <br />11. Lounty ~_ <br />12. Acreage ~~ <br />13• Fee ~- <br />\ <br />14. Present land use ~_ <br />15. Proposed future use <br />~~ <br />16. Signature ~ <br />Maps and Exhibits <br />EXHIBIT A - Legal Description <br />`~ <br />EXHIBIT B - Mining Plan ~ <br />EXHIBIT C - Map C~ <br />EXH IBIT D - Wildlife, Water Resources, <br />Vegetation, Soils Information v <br />