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±/77 fIIdED LAND RECLAPlATION • III IIIIIIIIIIIIIIII <br />sss <br />ReQU1ar (112) Permit Application Checklist <br />File Io. 77 -SS `1 Name V ~ i Go SSG • Date of Filing (Completeness) <br />ITEif COMPLETE ADEQUATE COMMENTS <br />Aoplication Form <br />1. i~ame of operation <br />'_. ;lame of applicant <br /> <br />3. Address fi phone (local offices) / <br />// <br />4. Address fi phone (gen'1. offices) <br />S. Person to contact <br />6. Parent corporation (if any) <br />7. Surface owners <br />8. Pfineral owners ~' <br />i <br />9. Type of mine/substance <br />.0. General location fi elevation ~ <br />.1. County ~ I ~ <br />2. Acreage <br />.3. Fee <br />I <br />4. Present land use <br />.~. Surrounding land uses <br />.6. Proposed future use <br />.7. Other mining permits <br />.8. Signature <br />.9. Prohibited Lands Statement <br />:taps S Exhibits <br />1. Legal description <br />2. Index may <br />3. Pre-mining fi mining plan map I <br />4. riming plan - a) timetable <br />- b) depth fi ckness of ore <br />1 ~ <br />ooay <br />