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<br /> <br />-2- <br />~ho./E <br />3. Address and Phone Number of 3°3 <br />Local Offices ~ ~/ / X~~ <br />l6SO ER 57` MR/~ S~REE~ 1/•z/NIDRD/ IORORHaO-S(O~Z '~%3'S< <br />4. Address and Phone Number of <br />General Offices r,1 ~ 8ok ~~z 303) 856 "SF?35'~ <br />5. Name and Phone Numb/er of Person <br />Staff Members Should Contact - <br />~lolirv TRFD IAt/EIIR ~tivNr (303) 8-irG -'~35~7 <br />6. Owner(s) of Record of Affected Land ~;~tl%~lt/~, <br />(surface area) (If more than 2, list below) /'~/N/D R p <br />Cc~rc--iERy r~~s~F/~7Y/U%I/ <br />7. Owner(s) of Substance to be Mined /K~n//d,g~ `Rt/rv/,ra <br />(If more than 2, list below) <br />c'~~+~r~y ass~,~/p1roN <br />8. Source of Legal Right-To-Enter X~R 0 X ~o R <br />(Indicate what type of proof is <br />included in EXHIBIT G -lease, k/,a,gRwN'(r UFr0 <br />deed, notarized letter, etc.) <br />9. Type of Mine and Substance to be Mined <br />(Specify underground, open pit, c(ARR - GIZR/~L - R°RD BAS r" <br />quarry, etc. & substance(s) to ~ y <br />be mined) <br />10. General Location and Elevation 2 MALES ~AS~ °f eENfEft of lR/NrDAp <br />(Miles & direction from nearest CnGoa,voo, ELc/R~roiv AauRax. .i29~ lt. <br />town & approximate site elevation) ~~pp ./ <br />/i4Q1 ~.S~~II~'! p'fIIC .SNJ~~ StC 8- %OwNS/rte 33 Ra~cF <br />11. county ~qs y/yrMgs <br />12. Acreage of Affected Lands <br />(Total surface acreage to be / AeRES MORE oa ~.ESS <br />included in permit) 3~, ~ 7 <br />13. Application Fee (See applicable SQ, pa ~,~v5 %S.oo ~ER AoRE ~` <br />Rule to determine amount) 9~ ©o <br />.5m.ovPX"3 ~ulsoo <br />