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<br />~ iii iiiiuiiiiiu iii ~ <br />,d MAN ~~~ <br />REGULAR (112) PERMIT <br />APPLICATION FORM <br />This form contains two mayor parts: (1) General Operation Information and (2) Exhibits <br />A-P. When you submit your application; be sure to include four s~i named copies of the <br />General Operation Information, four copies of Exhibits A-P; and a c ck 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 />vxevveavavaxavaeaxxxaaaaavaa:aexaaaaavaxaaaaaaaaaxsaaxaaavaaxaaaaaaxvxaaaavaaaavvavxveeve <br />GENERAL OPERATION INFORMATION <br />Type or print clearly; in the space provided; all information described below. <br />veve=exxavavvvvxvaxvaaaaaaaaeexxaaaaaxsaaxxaaavaaaaaavvasaxaxaanvaaaaaaaaaaxsaxevvvvvvv== <br />1. Applicant/Operator Name: -EAR t~ E -C Y PS U M P ~O DuGrS <br />2. Operation Name (Pit; mine or site name): Ef~rC~LE C YPSVYVI (~ ~Nl, <br />3. Application type: Regular (112) Permit Operation. <br />4. Application Fee for Permitted Acreage* 1f~Oq,lo(o permitted <br />~,~v acres. <br />AmeYOm (E~~09 + 3a-5:94/acre; 1st: 50 Gies; <br />5~`Sl~fle/acre, 2nd. 50 acres; S~~cre, 3rd: 50 acres; <br />d.sa$~00/acre; arty 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: ~ ODD °n application fee. <br />5. Substance(s) to be mined (e: g:; gold/silver/gravel): ~~/P~ u m <br />6. Owners(s) of Substance to be Mined <br />(check applicable box(s)): 1~ Private ` State _ Federal _ Indian <br />7. Owner(s) of Record of Affected Land <br />(check applicable box(s)): _ Private _ State ~ Federal _ Indian <br />S. Type of Mining Operation <br />(check applicable box(s)): Surface _ Underground u In-situ <br />9: Location Information. The center of the area where the majority of mining will <br />occur lies in: <br />COUNTY: EAC, L,~ <br />PRINCIPLE c ec one ~ p(6th (Colorado) 10th (New Mexico) Ute <br />TOWNSHIP (write number and check direction): T ~ North pC South <br />RANGE (write number and check direction): R Sr _ East ~C West <br />SECTION (write number): S 2 <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 / l11 i ~>/ N-G--. of Tam o.~ Frt~p6ysy~ <br />from nearest town and <br />approximate elevation) ~o `j '.S~ <br />* If the operator is a unit of State or county government, an application fee is no*. <br />required. A fraction of an acre must be counted as one acre for fee calculation.. <br />