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<br />-Z- <br />N <br />3. Address and Phone numoer of 117 White Pine Drive, Alamo$a CO 81101 <br />Local Offices (303) 589-5105 <br />4. Address and Phone Number of <br />General Uffices <br />same <br />5. idaine and Phone Number of Person <br />Staff i~lemoers Should i;ontact Mr. Lerov Relt <br />ti. Owner(s) ur Recoru of Affected Lana Henry Southway , J <br />(surface area) (If inor-e than 2, list belota)d/b/a So. Wav Co., <br />7. U~+ner(s) of Substance to be dined Henrv Southway, Jr. , <br />(If mare t'nan 2, list belo») d/h/a So. Wav Co., <br />...., <br />d. Suurce of Legal Right-To-Enter <br />(Indicate wnat type of proof is deed <br />included in EXHidIT G - lease, <br />aced, notarized letter, etc.) <br />9. Type of ~•iine and Substance to oe Mined <br />(Specify underyround, opan pit, <br />yuar•ry, etc. b suostance(s) to open nit, sand and gravel <br />ue mined) <br />lU. General Location and Elevation <br />(Hiles & direction from nearest <br />tuwn & approximate site elevation) <br />approximately twel e miles WNW of <br />Sapuache, Colorado <br />Elevation approxim tely 8,20n feet <br />11. l;ounty <br />Sa~uache <br />12. Acreage of Affected Lands <br />(Total surface acreage to be <br />included in permit) <br />Q.47 acres <br />13. Application Fee (See applicable <br />Mule to detarnine amount) 8125.00 <br />