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ZIA <br /> �1111l1111111��1�1� : ram; ��YY , <br /> 999 <br /> AUG 3 019�$ <br /> LIMITED IMPACT OPERATION (110) <br /> APPLICATION FORM <br /> This form contains two major parts: (1 ) General Operation Information and (2) Exhibits <br /> A-G. When you submit your application, be sure to include two signed copies of the <br /> General Operation Information, two copies of Exhibits A-G, and a�eck 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. <br /> ---------- ------------------------------------------------ _------ ------------------ <br /> GENERAL - �OPERATION INFORMATION <br /> Type or print clearly, in the space provided, all information described below. <br /> 1 . Applicant/Operator Name: Southway Construction Co. , Inc. <br /> 2. Operation Name (Pit, mine or site name): Swede Corners Pit <br /> 3. Application type: Limited Impact Operation 0 10): <br /> 4. Application Fee ($10 x (affected acres) + $25.00).* 9.9 affected acres. <br /> Note affected acreage and application fee and <br /> attach a check for this amount when you file. 125.00 application fee. <br /> 5. Substance(s) to be mined (e.g. , gold/silver/gravel ) : Sand S Gravel <br /> 6. Owners(s) of Substance to be Mined <br /> (check applicable box(s)): ❑ Private ❑ State ® Federal ❑ Indian <br /> 7. Owner(s) of Record of Affected Land <br /> (check applicable box(s)): ❑ Private ❑ State ® Federal ❑ Indian <br /> 8. Type of Mining Operation <br /> (check applicable box(s)): 13 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: Saguache <br /> PRINCIPLE MERIDIAN (c eck one): 6th (Colorado) (New Mexico) Ute <br /> TOWNSHIP (write number and check direction): T 43 ® North ❑ South <br /> RANGE (write number and check direction) : R 7 Q East ❑ West <br /> SECTION (write number) : S 2 <br /> QUARTER SECTION (check one) : ❑ NC— ❑ NW ❑ SE ® SW <br /> QUARTER/QUARTER SECTION (check one): ❑ NE 0 NW ❑ SE ❑ SW <br /> GENERAL DESCRIPTION: <br /> (miles and direction 6 miles South and 2 112 miles West of SacTuache <br /> from nearest town and <br /> approximate elevation) <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 />