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7/7$ III IIIIIIIIIIIIIIII <br />LIMITED .. ,.,,,,sss„~ _ <br />SPECIAL 10-DAY (I11) ~,2~. <br />ITEM <br /> APPLICATION L11 EC1CL I ST U- <br />S <br />~I6 <br />~~II i V.` <br />G NAME ~y.G`o~ ~fillvJ3 S <br />a <br />FILE c <br /> 11 <br />COMPLETE (FILED) DATE .~ <br /> <br />COMPLETE ADEQUATE COMMENTS <br />Application Form: <br />1. Name of operation <br />2. Name of applicantloperator <br />3. Address E phone, local <br />4. Address s phone, general <br />5. Person to contact <br />6. Surface owners c~ <br />7. Mineral owners <br />8. Source of legal right-to-enter <br />9. Type of mine/substance (% <br />10. General location 8 elevation <br />11. County j <br />12. Acreage / <br />V <br />13. Fee <br />rr " S~ ~!";':.;:.~ Nc:•, ~. c•.ci ~~ <br />14. Present land use <br />15. Proposed future use <br />16. Signature <br />Maps and Exhibits <br />EXHIBIT A - Legal Description <br />t// _. .,, <br />EXHIBIT 8 - Mining Plan <br />EXHIBIT C - Map <br />EXH k31T D - Wildlife, Water Resources, <br />Vegetation, Soils Information <br />