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Street Street <br /> 66t"�l d 41--' ct--,) <br /> x P.O. Box <br /> City, State, Zip City, State, Zip <br /> ( 72-o) <br /> Telephone Telephone <br /> ( ) ( ) <br /> Fax 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 /> 5. <br /> LOCATION INFORMATION: <br /> County: <br /> a� <br /> Principal Meridian (check one): <br /> th (Colorado) El10th Ute <br /> (VNew Mexico) 7F] <br /> Section (write number) ® TOWNSHIP ® N � S <br /> RANGE E FM7 W <br /> F[R-] <br /> QUARTER SECTION (check one): <br /> NE ❑ NW E SE �g SW <br /> QUARTER/QUARTER SECTION (check one): <br /> NE ❑ NW SE �g SW ❑ <br /> GENERAL DESCRIPTION: (the number of miles and direction to the nearest town and the <br /> approximate elevation): L <br /> 6 W• Ie S Sy U� k Pa S T (e)✓n v (�C? <br /> Form 2—Public File Page 2 of 14 <br />