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<br />-2- <br />:~ <br />C/lo NE <br />3. Address and Phone Number of 3o 3 <br />Local Offices .~ /~ S9G <br />i ~S~ ~~~ llfHln.- S~RfE~ /R/n'l Dr4A~ l'[~i~icRADO 8•lots2 y93~ <br />4. Address and Phone Number of ~o3-bH( <br />General Offices 93~f <br />P~, I~~k SSZ /RtNrDAl1 Cdc~inRADc SIOSZ <br />5. Name and Phone Number of Person <br />Staff Members Should Contact _ <br />i]c/tN ~REU lHc"E/lA C3o3) A'~6- 737`7 <br />6. Owner(s) of Record of Affected Land /~c~NtA.,A C~Afholi~p <br />(surface area) (If more than 2, list below) <br />L~[/r7E><ERy ~155oeistt/onl <br />7. Owner(s) of Substance to be Mined •12tN i Dra I~ ~Af kol. ~P <br />(If more than 2, list below) e~jr~EfeRr /955oni.~'f/o~U <br />3. Source of Legal Right-To-Enter k~2ou (1p~V <br />(Indicate what type of proof is / <br />included in EXHIBIT G -leas;, 6JflRRAn;~~ DEf1) <br />deed, notarized letter, etc. <br />9. Type of ~~7ine and Substance to be f4ined <br />(Specify underground, open pit, _ ~Ryy~~( _ /('oyp BRSf_ <br />quarry, etc. & substance(s) to ~..lRR2s/ <br />be mined) <br />10. General Location and Elevation ~ ~ M~Les E~rs-f or CEiL'1`ER eF %Kriu/DAA <br />(Miles & direction from nearest FOJ.cRr10o . E~Cer'~f~°'v i1PR,2ov 5? S'o~• <br />town & approximate site elevation) <br />~/{/{f ®F SW y5~ " .SCGf/wry ~, b,.:NS h~P .37 (ZANLF Ci 3 <br />11. County <br />~~s 9n'r~~I-as <br />12. Acreage of Affected Lands ~ AQ'ZES w' 1) t3E AFf.~efiE A <br />(Total surface acreage to be <br />included in permit) <br />13. Application Fee (See applicable <br />Rule to determine amount) <br /> <br />,l 6. A c 30, c~ = <br />®3.0. o ~~ <br />C R $l 1941,3 l/P1ENDfD <br />