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• III IIIIIIIIIIIII III ~ ~~~ ,~~,,,,; SPECIAL OPERATION (111) ~ ~ T ~ ~ )~€!~ APPLICATION FORM ~ t~Cik~r - Two copies of Exhibits A-H must be attached to the General Operation In orma iAdd'Updri.'.•~ submittal to the Division. Each exhibit must be presented separate from the other exhibits. f'or example, Exhibit A - Legal Description should be on page 1 and Exhibit B - Site Description should start on page 2. Please type the title of each exhibit at the top of each exhibit page. Please number the pages of Exhibits A-H consecutively for ease of reference. The following sections describe the minimum information that must be suppl ted for each exhibit: ~ • ~,~ . ~~(~, ----------------------------------------------------------------------------------------- GENERAL OPERATION INFORMATION Type or print clearly, in the space provided, all information described below. ----------------------------------------------------------------------------------------- 1. Applicant/Operator Name: ~ T ~,~z errs ~ ~ia y i N G ~O . 2. Operation Name (Pit, mine or site name): C,4 L_ l G 1-Er SG I--4ooc._ 1~ i T 3. Application type: Special Operation (111). 4. Application Fee for Permitted Acreage* 5 permitted acres. (S15 x (affected acres) + E200.00).* Note affected acreage and application fee and attach a check for this amount when you file. ~ ~ application fee. 5. Substance(s) to be mined (e.g., sand, gravel): 6. Owners(s) of Substance to be Mined (check applicable box(s)): (,Private ~ ~~~~7 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 9. Location Information. The center of the area where the majority of mining will occur lies in: COUNTY: L f7 G L~ PRINCIPLE MERIDIAN (check one): ~ 6th (Colorado) _ 10th (New Mexico) _ Ute TOWNSHIP (write number and check direction): T ~~ ~ North _ South RANGE (write number and check direction): R Sd _ East _X West SECTION (write number): S ..~ .~, "?N QUARTER SECTION (check one): X NE NW SE SW QUARTER/QUARTER SECTION (check one): ~ NE - NW - SE - SW GENERAL DESCRIPTION: (miles and direction ) rr1,~G Noa~ ~~~ ~ o~ (~cXCo~2, Cam. from nearest town and approximate elevation) pry C. (2. ~S L~r_v. 3~i3o Fem. * If the operator is a governmental subdivision or requires a permit solely for fulfilling a contract with the State Department of Highways, an application fee is not required. A fraction of an acre must be counted as one acre for fee calculation.