PERMFILE119232

• Permit No: M1977307
• IBM Index Class Name: Permit File
• Doc Name: LIMITED IMPACT & SPECIAL 10 DAY PERMIT APPLICATION CHECKLIST
• Section_Exhibit Name: EXHIBIT A & E
• Media Type: D
• Archive: No

4/77 • ~ III IIIIIIIIIIIIIIII
MLIED LIu~1D RECLAMATION
LIMITED IMPACT AND SPECIAL 10-DAY PERi~IT APPLICATION CHECKLIST
File No. 77-3U~Name CcJ~~.~/ C~~~ Ctit 25Date of Filing (Completeness)
ITE"1 COMPLETE ADEQUATE COMMEZTS
Application Form
I. Name of operation
(~
2. Name of applicant/operator
3. Address ~ phone (local offices) /'
4. Address 6 phone (general offices)
5. Person to contact
6. Surface owners
7. lSineral owners
S. Type of mine/substance
9. General location ~ elevation
10. County
11. Acreage 5'~ ~
I2. Fee
r~ 0
li gs
7 b r coo C. ¢~ g
13. Present land use
14. Proposed future use
15. Signature
Maps and Exhibits
I. Exhibit A - Legal description /
v/
2. Exhibit B - Piining plan
3. Exhibit C - Map
4. Exhibit D - Wildlife, Water Resources,
Vegetation and Soils infor-
mation /'
r~

~. Exhibit E - Reclamation plan _/
!/