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V E 0 <br />E." -P IA." <br />-JAN I U 191"9 <br />LIMITED IMPACT OPERATION 01,Q) MpIFL) <br />APPLICATION FORA 7. L,,Nt :_j <br />This form contains two major parts: (1) General Operation Ifif&mafion and '(2) Exhibits <br />A, 7G.-- When yb6 submi-i"-,y6i "Fi'�'pplication,--be,-Sure'#',to",incI ude 'two signed'copies of the <br />General Operation Information, two copies -of Exhibits A-G, and6e_c75_eck,4or the <br />appliciti6n-fee 4sc"r'i'6'iY'Lfn8&­(4) _bi%w: *16'6-pe'dite processing, ;please provide the <br />information in the format -and- order" - described 'in -this form. <br />----------- ----------- <br />.__.________777_7 -777 GENERAL QPERAI MN " INFORMATION <br />Ole <br />Type br,print c1&rlyj• in•the soace-prbvideb;'.�all' information 'described below. <br />-------- -= 7777 77 = 77---- -= -- -- ---- -= --- --_ -_ - = -_ L -------- <br />I Applicantibpe�ator Wme':* J,2de lilc-. <br />2. Oper6tion Name (Pit, mine or site ndme')i <br />site <br />3. Application type: Limited Impact Operation (110). <br />4r.- Application Fee for Permftted-Acreage* 8. —permitted acres. <br />($10 ic (affected acres) + $25.00).* <br />N6f4 permitted acreagle afi'd•appj.icaiti_6h fee'hhd <br />attach a,check for this amount when'you file. 210 application fee. <br />5. Substance(s) to be mined (e.g., gold/silver/gravel.): <br />�1 n-F-1 nmr�d rr C,11 AY <br />6.i Owners(s) of Substance to be Mined <br />(6he6k 'appli-Eabl-4 6o'ks)Y:­ 15 Privaib 0 State 0 Federal ❑ Indian <br />7. Owner(s) of Record of Affected Land <br />(check ipplicible b•6(i))- '93 Private. ❑ State ❑ Federal 0 Indian <br />B. Type of Mining Operation <br />(check app1ica6i'4­'b6i_(fl'):' M ,Surface 0 Underground ❑ In-situ <br />Ic I . .. * � . , h # - '1 1 14, - - * ' ' - ' . . <br />9. Location Infdrmation.' The'centee of t e.area'Whi� ,themajority of 011 <br />occur " i _ j 1 e§" in" <br />COUNTY*. ljro-werz, <br />PRINCIPLE MERIDI' Njcheck one)i_-Y6th (Col qyqdp� 0 j%h,(New Rxico,.)EI Ute <br />w'r'it6 '6Vmber"'alh�'6fiec reiRioA')- '" T 3 O'South <br />rc <br />er and check E) West <br />" 1' * * ' "' dfrecif6h) R '46 CY f� <br />R-ANGE.,_.(wr'1t'e' numb'. . Ea <br />r <br />Mttfibh N`fte nu'%6jr1)- <br />QUARTER SECTION (chedk one):' 0�NE 0 NW 0 SE 0 SW <br />QUARTER/QUARTER SECTION . (check o E9 N,E. 0, NW <br />❑ S 0, SW <br />GENERAL`- -DESCRIPTION: ' <br />e s "a ; a direction Mj.1e_V5,,oufth W—P at r I iwj <br />from nearest town and V <br />-j . , , <br />"a <br />01) r W <br />okimaeleyat­164) ...... <br />If the boi!rator` 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 />