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Ori9i~~.Q <br />~~ 9~t <br />gyp! ~- <br />• Ill 1111111111111111 <br />REGULAR (]12) PERMIT <br />APPLICATION FORM <br />• 1 e-1 T~ <br /> <br />~:. . <br />itG_r",511; itJ~ ~s!`Ji:iUfil <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 s~~iggne~~d copies of the <br />General Operation Information, four copies of Exhibits A-P, and aleck 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 />____________________________________________________________ ~_ ~===I1 y~ ,~d~a_a~_c~Ga9yr~ <br />~ - ---- <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, all information described below. <br />1. Applicant/Operator Name: Andesite Rock companv <br />2. Operation Name (Pit, mine or Site name): Carr Gravel Resource <br />3. Application type: Regular (112) Permit Operation. <br />4. Application Fee for Permitted Acreage* 1302 permitted <br />acres. <br />(E50.00 + E15.00/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 />E2,000.00).* <br />Mote permitted acreage and application fee and <br />attach a check for this amount when you file. ~~nnn application fee. <br />5. Substance(s) to be mined (e.g., gold/silver/gravel): <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 />COUNTY: We]d <br />PRINCIPLE MERID AN chec one ){$ 6th (Colorado) ^ 10th (New Mexico) ^ Ute <br />TOWNSHIP (write number and check direction): T 11 ® North ^ South <br />RANGE (write number and check direction): R 67 ^ East ~]: West <br />SECTION (write number): S 26 <br />QUARTER SECTION (check one): ^~- ~Q NW ^ SE ^ SW <br />QUARTER/QUARTER SECTION (check one): ^ NE ^ NW ^ SE i'.k SW <br />GENERAL DESCRIPTION: <br />(miles and direction 1/2 mile east of Carr, Colorado <br />from nearest town and <br />approximate elevation) F,P„at;,,,, ~~nn <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 />