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<br /> <br />' REGULAR (112) PERMIT <br /> APPLICATIDN 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 sk~i n~__e~~d copies of the <br /> General Operation Information, four copies of Exhibits A-P, and as e k 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 /> <br /> GENERAL OPERATION INFORMATION <br />' Type or print clearly, in the space provided, all information described below. <br /> <br />' 1. Applicant/Operator Name: Andesite Rock Comoanv <br /> 2. Operation Name (Pit, mine or site name): Carr ,r .e ] R rc <br />t 3. Application type: Regular (112) Permit Operation. <br /> 4. Application Fee for Permitted Acreage* X302 permitted <br /> acres. <br />1 (550.00 + 515.00/acre, 1st. 50 acres; <br /> 510.00/acre, 2nd. 50 acres; E5.00/acre, 3rd. 50 acres; <br /> 51.00/acre, any additional acreage; maximum fee of <br /> 52,000.00).* <br /> Note permitted acreage and application fee and <br /> attach a check for this amount when you file. c.~nnn application fee. <br /> 5. Substance(s) to be mined (e. g., gold/silver/gravel): Gary' _~~ ~ ra~~~~ <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 /> <br /> COUNTY: [aP] d <br />. <br /> PRINCIPLE MERIDIAN check one <br />X5 6th (Colorado) O 10th (New Mexico) ^ Ute <br /> TOWNSHIP (write number and check direction): T 11 p North p South <br /> RANGE (write number and check direction): R b7 ^ East X~ West <br /> SECTION (write number): S 26 <br /> QUARTER SECTION (check one): per- 1Q NW O SE p SW <br /> QUARTER/QUARTER SECTION (check one): ^ NE ^ NW ^ SE ~}; SW <br /> GENERAL DESCRIPTION: <br /> (miles and direction _1/2 mile ezst of Carr. Colorado <br /> from nearest town and <br /> approximate elevation) s[P„=.;,,., Sinn <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 />