REV14309

• Permit No: M1983084
• IBM Index Class Name: Revision
• Doc Date: 7/8/1989
• Doc Name: REGULAR 112 PERMIT APPLICATION FORM
• Type & Sequence: SO1
• Media Type: D
• Archive: No

. ,
IIIIIIIIIIIIIIIIIII ~C~~~"~~
REGULAR (112) PERMIT ~ u~ S 1989
APPLICATION FORM MINES Lr;,.~.
RECLAMATION (~SV~f~d
This form contains two major parts: (1) General Operation Information an its
A-P. When you submit your application, be sure to include four signed copies of the
General Operation Information, four copies of Exhibits A-P, and aT eck for the
application fee described under (4) below. To expedite processing, please provide the
information in the format and order described in this form.
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GENERAL OPERATION INFORMATION
Type or print clearly, in the space provided, all information described below.
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1. Applicant/Operator Name:
2. Operation Name (Pit; mine or site name): snow storm site
3. Application type: Regular (112) Permit Operation.
4. Application Fee for Permitted Acreage* permitted
acres.
(E5O.OO + X15.00/acre, 1st. 50 acres;
X10.00/acre, 2nd. 50 acres; E5.OO/acre, 3rd. 50 acres;
$1.00/acre, any additional acreage; maximum fee of
E2,OOO.OO).*
Note permitted acreage and application fee and
attach a check for this amount when you file. application fee.
5. Substance(s) to be mined (e. g.; gold/silver/gravel):
6. Owners(s) of Substance to be Mined
(check applicable box(s)): .x Private _ State _ Federal _ Indian
7. Owner(s) of Record of Affected Land
(check applicable box(s)): ~ Private _ State _ Federal _ Indian
8. Type of Mining Operation
(check applicable box(s)): ~ Surface _ Underground _ In-situ
9. Location Information. The center of the area where the majority of mining will
occur lies in:
COUNTY: Par!c
PRINCIPLE c ec one 6th (Colorado) 10th (New Mexico) Ute
TOWNSHIP (write number and check direction): T North _ South
RANGE (write number and check direction): R -_ East _ West
SECTION (write number): S
QUARTER SECTION (check one): tom- NW SE SW
QUARTER/QUARTER SECTION (check one): _ NE _ NW _ SE _ SW
GENERAL DESCRIPTION:
(miles and direction
from nearest town and
approximate elevation)
* If the operator is a unit of State or county government, an application fee is not
required. A fraction of an acre must be counted as one acre for fee calculation.