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. � a !11�111111l1111 <br /> J U L <br /> REGULAR (112) PERMIT MINED LAND <br /> APPLICATION FORM ?ECLAMATION DIVIS10"" <br /> This form contains two major parts: (1 ) General Operation Information and (2) Exhibits <br /> A-P. When you submit your application, be sure to include four signed copies of the <br /> General Operation Information, four copies of Exhibits A-P, and a- cTieck for the <br /> application fee described under (4) below. To expedite processing, please provide the <br /> information in the format and order described in this form.GENERAL OPERATION INFORMATION <br /> Type or print clearly, in the space provided, all information described below. <br /> 1. Applicant/Operator Name: Western-Mobile, Inc. <br /> 2. Operation Name (Pit, mine or site name): Greel?.v weer ( -7 -R1) <br /> 3. Application type: Regular (112) Permit Operation. <br /> 4. Application Fee for Permitted Acreage* 200 permitted <br /> acres. <br /> ($50.00 + $15.00/acre, lst. 50 acres; <br /> $10.00/acre, 2nd. 50 acres; $5.00/acre, 3rd. 50 acres; <br /> $1.00/acre, any additional acreage; maximum fee of <br /> $2,000.00).* <br /> Note permitted acreage and application fee and <br /> attach a check for this amount when you file. application fee. <br /> 5. Substance(s) to be mined (e.g. , gold/silver/gravel) : sand and gravel <br /> 6. Owners(s) of Substance to be Mined <br /> (check applicable box(s)): x Private ` State ! Federal _ Indian <br /> 7. Owner(s) of Record of Affected Land <br /> (check applicable box(s)): x Private State _ Federal Indian <br /> 8. Type of Mining Operation <br /> (check applicable box(s) ) : x Surface Underground In-situ <br /> 9. Location Information. The center of the area where the majority of mining will <br /> occur lies in: <br /> COUNTY: Weld <br /> PRINCIPLE c ec one : 6th (Colorado) loth (New Mexico) . Ute <br /> TOWNSHIP (write number and check direction): T 6 x North South <br /> RANGE (write number and check direction): R 66 ` East West <br /> SECTION (write number): S g6 <br /> QUARTER SECTION (check one): -Nr— NW SE SW <br /> QUARTER/QUARTER SECTION (check one): — NE NW SE SW <br /> GENERAL DESCRIPTION: — — — <br /> (miles and direction 1 mile NW of Greeley <br /> from nearest town and <br /> approximate elevation) 4,66ot MSL <br /> If the operator is a unit of State or county government, an application fee is not <br /> required. A fraction of an acre must be counted as one acre for fee calculation. <br />