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<br />-2- <br />3. Address and Phone Number of <br />Local Offices <br />Washington County Courthouse <br />Akron, CO 80720 <br />Phone 345-6565 <br />4. Address and Phone Number of same as Above <br />General Offices <br />5. _ Name and Phone Number of Person Paul Florian-County Commissioner <br />Staff Members Should Contact Phone 345-6565 <br />6. Owner(s) of Record of Affected Land James. P. Fassler <br />(surfdCe area) (If more than 2, list belOW)36495 Co. Rd. 36 <br />Akron, CO 80720 <br />7. Owner(s) of Substance to be Mined William Palmer Jackson <br />(If more than 2, list below) 187o Sunrise Dr. <br />Vista. CA 92083 <br />8. Source of Legal Right-To-Enter <br />(Indicate what type of proof is <br />included in EXHIBIT G - lease, <br />deed, notarized letter, etc.) <br />9. Type of Mine and Substance to be Mined <br />(Specify underground, open pit, Open Pit-Gravel <br />quarry, etc. & substance(s) to <br />be mined) <br />10. General Location and Elevation Elevation 4679 Feet <br />(Miles & direction from nearest 1 mile South and 4 1/4 miles <br />town & approximate site elevation) west of Akron on County <br />Road 40 and Y. <br />11. County Washington <br />12. Acreage of Affected Lands <br />(Total surface acreage to be 9.9 Acres <br />included in permit) <br />13. Application Fee (See applicable N/A <br />Rule to determine amount) <br />