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4/77 <br />i MINED LAND RECLAPfATION <br />Regular (112) Permit Application ChecY,list <br />III IIIIIIIIIIIII III <br />sss <br />File :Io. ~"S~~Name SG~w~-~~'f'-T-iu.go Date of Filing (Completeness) <br />ITEid COMPLETE ADEQUATE COT4fENT5 <br />Aoplication Form <br />1. Name of operation <br />2. Name of applicant <br />3. Address ~ phone (local offices) <br />4. Address b phone (gen'1. offices) ~ - <br />5. Person to contact ~ <br />o. Parent corporation (if any) <br />7. Surface owners <br />3. ?4ineral owners <br />i <br />9. Type of mine/substance <br />O. General location 6 elevation ~ <br />1. County ~ ~ <br />.2. Acreage ~ ~ <br />3. Fee <br />4. Present land use <br />f. Surrounding land uses ~ <br />o. Proposed future use <br />7. Other mining permits ~ _` <br />8. Signature <br />9. Prohibited Lands Statement <br />*laps b Exhibits <br />1. Legal description ` / <br />/ <br />/ <br /> <br />2. Index map / <br />/ <br />v <br />i. Pre-mining 6 mining plan map [/ <br />Mining plan - a) timetable I v <br />- b) depth b thickness of ore <br />i <br />oo ay <br />