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Street Street <br /> P.O. Box P.O. Box 1 <br /> cc� Q0.\AcG l CAyi 1� <br /> City,State,Ap City, State,Zip <br /> C:u0 ana- �l� ` 1 (-A\CA) <br /> Telephone Telephone <br /> ) . �� ;�. ( ) ; r <br /> Fax �—in o Fax <br /> 4. APPLICATION FEE: $86. (NOIs require an $86 fee which must accompany this notice <br /> or it cannot be processed by the Division). <br /> S. <br /> LOCATION INFORMATION: <br /> County: <br /> Principal Meridian (check one): <br /> 6th (Colorado) loth Ute <br /> ® (New Mexico) rl <br /> 7ect'ion (write number) TOWNSHIP N So <br /> RANGE [;�.17 E W 10 <br /> QUARTER SECTION (check one): <br /> NE ❑ NW SE SW <br /> QUARTER/QUARTER SEC ON (check one): <br /> NE NW SE � SW <br /> GENERAL DESCRIPTION: (the number of miles and direction to the nearest town and the <br /> approximate elevation): <br /> Form 2—Public File Page 2 of 14 <br />