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General Description (Miles and direction from nearest town and approximate elevation): <br />Three miles west of Segundo and approximately 20 miles west of Trinidad, <br />Colorado, on Highway 12. <br />Not for DP Ent <br />Permitted <br />Actual <br />Proposed <br />8. Mineral ownership: <br />Indicate currently permitted acreage for each <br />Federal: 0 acres <br />State: 0 acres <br />Private: 3142 acres <br />Indian: 0 acres <br />9. Surface ownership: <br />Indicate currently permitted acreage for each <br />Federal: 0 acres <br />State: 0 acres <br />Private: 3142 acres <br />Indian: 0 acres <br />10. Affected area in acres <br />129.3 <br />129.3 <br />129.3 <br />11. Disturbed area in acres <br />129.3 <br />129.3 <br />129.3 <br />12. Acreage of area reclaimed in previous permit term <br />A. Backfilled and graded <br />N/A <br />N/A <br />B. Reto soiled <br />N/A <br />N/A <br />C. Reseeded <br />N/A <br />N/A <br />13. Acreage for which bond has been released <br />A. 60 percent <br />N/A <br />122.1 <br />N/A <br />B. 85 percent <br />N/A <br />N/A <br />C. 100 percent <br />N/A <br />27.2 <br />N/A <br />14. Renewal Tenn Requested Years <br />N/A <br />N/A <br />5 <br />Note: If the application contains proposed (new) acreage, then a permit revision application <br />form must also be completed for those acreages. <br />15. TVDe of Mine (Check one): C11.1nderground I v Surface <br />F—Combined Surface and Underground <br />❑_oadout C Other <br />