2015-11-06_REVISION - M1977081

• Permit No: M1977081
• IBM Index Class Name: REVISION
• Doc Date: 11/6/2015
• Doc Name: Notices AR02
• From: DRMS
• To: various
• Type & Sequence: AR2
• Email Name: PSH
• Media Type: D
• Archive: No

� NIIIIIIIIIIINIpI
REGULAR (112) PERMIT
APPLICATION FORM
TT-
JUL ?11989
MINYD LAND
RECLAMATION DIVISION
This form contains two major parts: (1) General Operation Information and (2) Exhibits
A -P. When you submit your application, be sure to include four signed copies of the
General Operation Information, four copies of Exhibits A -P, and a aleck for the
application fee described under (4) below. To expedite processing, please provide the
information in the format and order described in this form.
s = =
GENERAL OPERATION INFORMATION
Type or print clearly, in the space provided, all information described below.
1. Applicant/Operator Name: Western -Mobile, Inc.
=
2. Operation Name (Pit, mine or site name): Greeley West (M -77-R1)
3. Application type: Regular (112) Permit Operation.
4. Application Fee for Permitted Acreage* 200
acres.
($50.00 + $15.00/acre, 1st. 50 acres;
$10.00/acre, 2nd. 50 acres; $5.00/acre, 3rd. 50 acres;
$1.00/acre, any additional acreage; maximum fee of
$2,000.00).*
Note permitted acreage and application fee and
attach a check for this amount when you file.
permitted
application fee.
5. Substance(s) to be mined (e.g., gold/silver/gravel): sand and gravel
6. Owners(s) of Substance to be Mined
(check applicable box(s)):
7. Owner(s) of Record of Affected Land
(check applicable box(s)):
8. Type of Mining Operation
(check applicable box(s)):
9. Location Information.
occur lies in:
x Private
x Private
x Surface
State T Federal _ Indian
State
_ Federal , Indian
Underground In-situ
The center of the area where the majority of mining will
COUNTY: Weld
PRINCIPLE MERI61AN (check one):. 6th (Colorado) 10th (New Mexico) Ute
TOWNSHIP (write number and check direction): T 6 x North South
RANGE (write number and check direction): R 66 — East X West
SECTION (write number):
QUARTER SECTION (check one):
QUARTER/QUARTER SECTION (check one):
GENERAL DESCRIPTION:
(miles and direction
from nearest town and
approximate elevation)
S 36
NW
— NE
1 mile NW of Greley
4,660' MSL
NW
SE SW
SE ` SW
* If the operator is a unit of State or county government, an application fee is not
required. A fraction of an acre must be counted as one acre for fee calculation.