Applications for waivers of the location requirements of §75.1712-6 shall be filed with the Coal Mine Safety District Manager and shall contain the following information:

(a) The name and address of the mine operator;

(b) The name and location of the mine;

(c) The thickness of the coal seam in each working place in the mine for which a waiver is requested; and

(d) Other physical restrictions in the mine (for example, poor roof conditions, excessive water, timbering, etc.).

If a sanitary toilet cannot be installed within 500 feet of a working place because of physical conditions other than the thickness of the coal seam, the operator shall also include a short statement specifying areas in the mine which could be considered possible alternative sites for installation of such facilities.