Laserfiche WebLink
<br />`:, <br />f~,~~R ~ p ~~~~, <br />' ~ .. .. ~7~;h <br />REGULAR (112) PERMIT '`~~='~"`~ <br />APPLICATION FORM ~ ~ ,~ ,r.~'~ ~~~J~d~ <br />'This form contains two aa~or parts: (1) General Operation Infornatlon and (2) Exhibits <br />A-P, Nhen you submit your application, be sure to include four __s__i~~ne~~d~ copies of the <br />General Operation Information, four copies of Exhlblts A-P. and a~ck for the <br />1 application fee desc H bed under (4) below. To ezpedTte processing, please p vide the <br />information in the fornat and order described 1n this form. /~. ~ ~ _ 4~ <br />' iiiiiitiiiiiliitiititititiiii GENERAL iOPERATION INFORMATION ..i.... ii.. i.ii..i..ii.. <br />Type or print clearly, in the space provided. all Information described below. <br />itiiiiiiiiiiitiiiiiiiiiiiiii^iitiiiiiiitfiiiiitiiiiiiititiiiiiiititiiiiitiiiiitiiiiiiiifi <br />1 1. Applicant/Operator Name: _rna, (`rcck Anc rnirrnc <br />' 2. Operation Name (Pit, aloe or site name): ,.nom, moor norn„rno <br />3. Application type: Regular (112) Permit Operation. <br />' 4. Application Fee for Permitted Acreage* i_~en permitted <br />acres. <br />(150.00 ~• :15,00/acre, 1st. 50 acres; <br />-- ~ -;10.00/acre. 2nd. 50 acres; =5.00/acre. 3rd. 50 acres; <br />=1.00/acre, aqy additional acreage; aaxlaum fee of <br />:2,000.0(1).+ <br />' Mote pernitted acreage and appllcatlon fee and <br />attach a check for this amount when you file. T~•nnn application fee. <br />5. Substance(s) to be ained (e. g., gold/sitter/gravel): <br />qi,. a <br />6. Owners(s'I of Substance to be Mined <br />(check applicable box(s)): O PN vate ®c State O Federal O Indian <br />' 7. Owner(s) of Record of Affected Land <br />(check applicable box(s)): O Private 6EcState O Federal O Indian <br />' 8. Type of Mining Operation <br />(check applicable box(s)): ~j( Surface O Underground O In-situ <br />' 9. Location Information. The center of the area where the aa,)orlty of mining will <br />occur lies in: <br />' COUNTY: , <br />PRINCIPLE a c ecc one {{}} 6th (Colorado) O 10th (New Mexico) O Ute <br />TONNSHIP (write number and check Qi•rectlon): T ~_ O North fl South <br />RANGE (write number and check direction): R _.SLL O East 1tI{ Nest <br />' SECTION (write number): S <br />QUARTER SECTION (check one): O~ O MN ~ SE O SM <br />QUARTER/QUARTER SECTION (check one): O NE O NN O SE O SN <br />GENERAL DESCRIPTION: <br />(miles and direction p, one (`nal C`roPk hPturPPn F._ Orin V AV and <br />from nearest town and <br />approxlmat! elevation) f,a Arapaho - .lbP o ~n V 1 n 5900'. elev. <br />' • If the operator 1s a unit of State or county goverrwent, an appllcatlon fee is not <br />required. A fraction of an acre oust be counted as one acre for fee calculation. <br />