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<br />~II ~II~II~I~~~~~ ~I~ <br />SPECIAL OPERATION (111) <br />APPLICATION FORM <br />Two copies of Exhibits A-H must be attached to the General Operation Information upon <br />i submittal to the Division. Each exhibit must be presented separate from the other <br />exhibits. For example, Exhibit A - Legal Description should be on page 1 and Exhibit B <br />- Site Description should start on page 2. Please type the title of each exhibit at the <br />top of each exhibit page. Please number the pages of Exhibits A-H consecutively for <br />ease of reference. The following sections describe the minimum information that must be <br />supplied for each exhibit. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, all information described below. <br />------ ------------------------------------------------ <br />1. Applicant/Operator Name: sesc-way Pavin¢ co. <br />~ Z. Operation Name (Pit, mine or site name): ~a~l~he s~h~oi P;c <br />3. Application type: Special Operation (111). <br />4. Application Fee for Permitted Acreage* permitted acres. <br />($15 x (affected acres) + E200.00).* <br />Note affected acreage and application fee and <br />attach a check for this amount when you file. application fee. <br />5. <br />6. <br />7. <br />8. <br />9. <br />Substance(s) to be mined (e.g., sand, gravel): <br />Owners(sl of Substance to be Mined <br />(chuck applicable box(s)): _ Private _ State _ Federal _ Indian <br />Owner(s:) of Record of Affected Land <br />(check applicable box(s)): _ Private _ State _ Federal _ Indian <br />Type oi' Mining Operation <br />(check applicable box(s)): _ Surface _ Underground <br />Location Information. The center of the area where the majority of mining will <br />occur lies in: <br />COUNTY: <br />PRINCIPLE MERIDIAN (check one): _ 6th (Colorado) <br />TOWNSHIP (write number and check direction): T _ <br />RANGE (write number and check direction): R _ <br />SECTION (write number): S <br />_ 10th (New Mexico) _ Ute <br />_ _ North _ South <br />East West <br />QUARTER SECTION (check one): _ NE _ NW _ SE _ SW <br />QUARTER/QUARTER SECTION (check one): _ NE _ NW _ SE _ SW <br />GENERAL DESCRIPTION: <br />(miles and direction <br />from nearest town and <br />approximate elevation) <br />* If the op<~rator is a governmental subdivision or requires a permit solely for <br />fulfilling a contract with the State Department of Highways, an application fee is not <br />required. A fraction of an acre must be counted as one acre for fee calculation. <br />