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` . ill flifliflilfiilfl !���,,�� �r� <br /> LIMITED IMPACT OPERATION (110(2) ) UH 16 1992 <br /> RECLAMATION PERMIT Alined Lar1d <br /> APPLICATION FORM <br /> ,,? <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 (2) signed originals of the <br /> application form, two (2) copies of Exhibits A-J , and a cchecR for the application fee <br /> described under (3) below. To expedite processing�pleasero e th information in <br /> theformat and order described in this form. <br /> GENERAL OPERATION INFORMATION <br /> Type or print clearly, in the space provided, all information described below. <br /> U6X"5(cy�— -91-6 73 <br /> 1 . Applicant/operator name: KIOWA COUNTY ' <br /> 1 .1 Type of organization (corporation, partnership, etc. ): Local Government <br /> 2. Operation name (pit, mine or site name): FERRIS PIT <br /> 2.1 I.R.S. Tax ID No. or Social Security No.: JEEK_ <br /> 3. Application fee for permitted acreage* 9.8 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. application fee <br /> 4. Substance(s) to be rained (e.g. , gravel/gold/borrow): GravQl <br /> 5. Name of owner of surface of affected land: Robert Ferris <br /> 6. Name of owner of subsurface rights of affected land: Robert Ferris- <br /> 7. Type of mining operation: xx Surface Underground In-situ <br /> 8. Location information. The center of the area where the majority of mining will <br /> occur lies in: <br /> COUNTY: CHEYENNE <br /> PRINCIPAL MERIDIAN (check one): xx 6th (Colorado) loth (New Mexico) Ute <br /> TOWNSHIP (write number and check direction): T .1h- North "youth <br /> RANGE (write number and check direction): R LL East = West <br /> SECTION (write number): S XX <br /> NE <br /> QUARTER SECTION (check one): NW SE Sw - <br /> QUAR TER/QUARTER SECTION (check one): xY NW SE Sw <br /> GENERAL DESCRIPTION: —` <br /> (miles and direction From Haswell, go East on Highway 96, 1 42 milga <br /> from nearest town and turn North on C.R. 21 and go 12 1/2 miles, Turn <br /> approximate elevation) East on Road B�B and go 1 mile, Tun V rth 2 miles. <br /> then West 1/2 mile. <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 />