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NEUCIV tEU <br /> JUL 031991 <br /> LIMITED IMPACT OPERATION (110(2) ) Mined Land <br /> RECLAMATION PERMIT 'declamation Divjscon <br /> APPLICATION FORM <br /> The application for a Limited Impact Operation Reclamation Permit contains three major <br /> parts: (1 ) the application form; (2) Exhibits A-J ; and, (3) the application fee. When <br /> you submit your application, be sure to include two (21 signed originals of the <br /> application form. two (2) copies of Exhibits A-J. and a check-for the application fee <br /> described under (3) below. To expedite processing. please pro ide the information in <br /> the format and order described in this form. "!J ,�„,n-1/ o/ <br /> GENERAL OPERATION INFORMATION "L`r <br /> Type or print clearly, in the space provided, all information described below. <br /> 1 . Applicant/operator name: /alptvd.id a*J /9./ii,4. c74/1c <br /> 1 .1 Type of organization (corporation. partnershipt�99 etc.): /f y.,c ‘e.'5.2. Operation name (pit, mine or site name) : /! <br /> s- 9«, 4 CP-4 4,,, I ie/,f <br /> 2.1 I.R.S. Tax ID No. or Social Security No. : S 2 / -6 r7 •6i 1/i y <br /> 3. Application fee for permitted acreage* /Q permitted acres <br /> ($25. .00 + 10/acre)* <br /> Note permitted acreage and application fee and <br /> attach a check for this amount when you file. 'f2 S•D o - application fee <br /> 4. Substance(s) to be mined (e.g. . gravel/gold/borrow) : <br /> 5. Name of owner of surface of affected land: hipGvers_erifgr,/.1,rt.,4.-f�1oye <br /> 6. Name of owner of subsurface rights of affected land: moo„•,,,,f y,,/ /sr' vi4 5-7`, <br /> 7. Type of mining operation: (/Surface Underground _ In-situ <br /> 8. Location information. The center of the area where the majority of mining will <br /> occur lies in: <br /> COl'NTY: / 3//ter <br /> PRINCIPAL MERIDIAN (check one) : ii 6th (Colorado) 10th (New Mexico) Ute <br /> TOWNSHIP (write number and check direction) : T Eyf North i!53uth <br /> RANGE (write number and check direction): R 7 p„g — East Wiest <br /> SECTION (write number) : S <br /> QUARTER SECTION (check one): NW SE SW <br /> QUARTER/QUARTER SECTION (check one) : je.(dE NW SE _ SW <br /> GENERAL DESCRIPTION: <br /> (miles and direction 1p L ol /rr c-,f#' c/' /kr/SStit7'J ral <br /> from nearest town and <br /> approximate elevation) <br /> * A fraction of an acre must be counted as one acre for fee calculation. If the <br /> operator is a unit of state or county government, an application fee is not required. <br />