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fJ/ • • <br />REGULAR (112) PERMIT <br />APPLICATION FORM <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-Teck 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 />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, all information described below. <br />----------------------------------------------------------------------------------------- <br />----------------------------------------------------------------------------------------- <br />1. Applicant/Operator Name: <br />2. Operation Name (Pit, mine or site name): <br />3. Application type: Regular (112) Permit Operation. <br />4. Application Fee for Permitted Acreage* permitted <br />acres. <br />(550.00 + E15..00/acre, 1st. 50 acres; <br />E10.00/acre, 2nd. 50 acres; E5.00/acre, 3rd. 50 acres; <br />E1.00/acre, any additional acreage; maximum fee of <br />E2,000.00).* <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): <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)): ^ 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: <br />PRINCIPLE MERIDIAN chec one ~ ^ 6th (Colorado) ^ 10th (New Mexico) ^ Ute <br />TOWNSHIP (write number and check direction): T ^ North ^ South <br />RANGE (write number and check direction): R ^ East ^ West <br />SECTION (write number): S <br />QUARTER SECTION (check one): ^~~ ^ NW ^ SE ^ SW <br />QUARTER/QUARTER SECTION (check one): ^ NE ^ NW ^ SE ^ SW <br />GENERAL DESCRIPTION: <br />(miles and direction <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 />