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111 II1f111llllll IIl <br /> RECEIVED <br /> 999 <br /> JUN 19 19g1 <br /> LIMITED IMPACT OPERATION (110(2)) Mined Land <br /> APPLICATION FORM Reclamation Division <br /> The Application for a Limited Impact Operation Reclamation Permit contains three major <br /> parts: (1 ) the Application Form, (2) the Application Exhibits A-F, and (3) the <br /> application fee. When you submit your Application, be sure to include two signed copies <br /> of the Application Form, two copies of Exhibits A-F, and a check for the ap'plication fee <br /> described under (4) below. To expedite processing, please provide the information in <br /> the-format_and_order-described'in_this-form. <br /> (_� <br /> GENERAL OPERATION INFORMATION <br /> Type or print clearly, in the space provided, all information described below. <br /> 1 . Applicant/Operator Name: Kit' Carson County <br /> 2. Operation Name (Pit, mine or site name): HeintRes_Pit <br /> 3. Application type: Limited Impact Operation (110). <br /> 4. Application Fee for Permitted Acreage* 9.9 permitted acres. <br /> ($10 x (affected acres) + $25.00).* <br /> Note permitted acreage and application fee and <br /> attach a check for this amount when you file. N/A application fee. <br /> 5. Substance(s) to be mined (e.g., gold/silver/gravel ): Sand & Gravel <br /> 6. Owners(s) of Substance to be Mined <br /> (check applicable box(s)): X Private State Federal Indian <br /> 7. Owner(s) of Record of Affected Land <br /> (check applicable box(s)): X Private State Federal Indian <br /> 8. Type of Mining Operation <br /> (check applicable box(s)): X Surface _ Underground In-situ <br /> 9. Location Information. The center of the area where the majority of mining will <br /> occur lies in: <br /> COUNTY: Che enne � <br /> PRINCIPLE MERIDIAN ✓6 check one): th (Colorado) lOth (New Mexico) Ute <br /> TOWNSHIP (write number and check direction): T 12 North X South <br /> RANGE (write number and check direction): R 43 — East X West <br /> SECTION (write number): S 1 <br /> QUARTER SECTION (check one): X NE _ NW SE SW <br /> QUARTER/QUARTER SECTION (check one): _ NE NW SE SW <br /> GENERAL DESCRIPTION: <br /> (miles and direction From Arapahoe 3/4 Mi East, 13 1/2 Mi North <br /> from nearest town and <br /> approximate elevation) on County Rd 54. Elev. - 4136 <br /> * If the operator 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 />