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5. NAMES AND ADDRESSES OF ADJOINING PROPE RTV OWNERS, LESSEES, ETC., WHOSE PROPE RTV ALSO ADJOINS THE WATERWAY <br />West Elk Coal Company <br />a. WATE RBODY AND LOCATION ON WATE RBODV WHERE ACTIVITY E%1575 OR IS PROPOSED <br />North Fork Gunnison River <br />Cluulison County, Colorado <br />7. LOCATION ON LAND WHERE ACTIVITY EkISTS OR IS PROPOSED <br />ADDRESS: Pdjacent to Highway 133 approximately 1 mile east of the town of Scnterset. <br />STREET, ROAD, ROUTE OR OTHER DESCRIPTIVE LOCATION <br />~luvlison Colorado 81434 - ° 135 90W <br />.iec. Tw-~~ -~.~~ <br />COVN7Y STATE ZIP CODE Tae AtdesfDrs DsacriptiGn- ~ <br />1 <br />LOCAL GOVERNING BOD~Y~W InT Hr~JURISD~ILC~ION OVER SITE Map ND' Subd ~ <br />B. b enY portion Of the etllvity 1pr which authorireUpn if feupht now cam PleHi ^ YE$ ^ NO <br />I} enrWar Ir "Vaj' plus raefOnf, month end YYr the eCL~YitV wet COmplete0 neltate the eR~Rinp work On Iha ErawinpF, <br />9. LIrt ell apprpveb er cotifltapoM ens Ombb r•Nivb Irom other Nderal, ingnute, nets or local epencief for any aructwn, eonnruetlOn, <br />tlKharpef Or ptner aCt:v,t Tee pefCrlbatl in thir lDpiCetiOn. <br />ISSVING AGENCY TYPE APPROVAL IDENTIFICATION NO. DATE OF APPLICATION DATE OF APPROVAL GATE OF DENIAL <br />~~~~ ~ ~~~ <br />JAN G 1988 <br />MINED LANG <br />RECLAMATI N DI I I <br />10. Appllgtlpn b hweby mesa ter • permit or OvmIL to euthorire Ne eeUYlt4f tleeerlbea Mnln. I cwbly that I em lamllbr wleh the Inlermaf fan <onHlned In <br />thb ePPllo[lon, and that to tM ben Of mY knpwledpe an0 bend sash Infprmeflen h true, cam Dbb, entl eeeunn. I further eertlfY 1Nt 1 poeaen the <br />euthOrltY to uneuvke IM OroPOeetl set ivltiq ar I am attlnp a the aulV autherire0 spent OI Na epDllcant. <br />/ V <br />IGNATURE OF APPLICAN GATE SIGNATURE OF AGENT GATE <br />The application must 6e aigned 6y the person who desires to undertake the proposed activity (applicant) or it may 6e signed by a duty <br />authorized agent i/ the statement in Block 3 has been /Tiled out and aigned <br />18 U.S.C. Section 1001 provides that: Whoever, in any manner within the jurisdiction of any department or agency o[ The United State <br />knowingly end willfully feleifiee, conceals, or rovers up by any trick, scheme, or device a material feet or makes any false, Gctitioue or <br />(ra udulent atatemente or reprexntationa or makes or uses any false writing or document knowing acme to contain any Cslse,fiMitious or <br />[reudulent statement or entry, shell be fined not more than 510,000 or imprisoned not more then five years, or both. <br />Do not send a permit processing fee with this application. The appropriate fee will be assessed when a permit is issued. <br />