Laserfiche WebLink
- , „ iii iiiiiiiiniiiiii <br />REGULAR (112) PERMIT <br />APPLICATION FORM <br />This form contains two mayor parts: (1) General Operation Information and (2) Exhibits <br />A-P, When you submit your application, be sure to include four sig~ned copies of the <br />General Operation Information, four copies of Exhibits A-P, and as c~ecc 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 />~eeeeeenee¢ee.eeeeea--ee-aa-------------veeaa-ee--------aveea~ee~_-a------e--__-eee-____- <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, all information described below. <br />1. Applicant/Operator Name: <br />2, Operation Name (Pit, mine or site name): ~yJ~ ~~ ~;~aJ,,, P~ <br />3. Application type: Regular (112) Permit Operation. '~~°O °"`~s`^"°~p'"'""'#4GA1'0 <br />4. Application Fee for Permitted Acreage* ~~e„„,,,,~,,,,~,~„,d( 73,6L7/ permitted <br />" acres. <br />(550.00 + ;15.00/acre, 1st. 50 acres; ~as~ (i7.so {i8 ) =~iGO. o-0 <br />510.00/acre, 2nd. 50 acres; 55.00/acre, 3rd. 50 acres; <br />51,00/acre, any additional acreage; maximum fee of <br />52,000.00).* <br />Note permitted acreage and application fee and <br />attach a check for this amount when you file. ~/~ O~oo 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 )): rivate 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 ma,)ority of mining will <br />occur lies in: <br />COUNTY: ~~c~ <br />~ <br />PRINCIPLE c ec one ® (Colorado) 10th (New Mexico) Ute <br />TOWNSHIP (write number and che ck direction): T i S• North South <br />RANGE (write number and check direction): R ~~, East West <br />SECTION (write number): <br />QUARTER SECTION (check one): S G <br />~ <br />NW SE <br />QUARTER/QUARTER SECTION (check one): NE ~ SE SW <br />GENERAL DESCRIPTION: <br />(miles and direction y~(,e~~~~j~~ m„ ~irduc../it.9ea. P <br />from nearest town and <br />approximate elevation) ~ ~~ ' /~ s,~ <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 />