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Bureau of Land Management Appendices <br /> Royal Gorge Field Office DOI-BLM-CO-FO20-2020-0036 EA <br /> 6.2. APPENDIX B- CDRMS 110 C PERMIT <br /> _ # RECEIVED <br /> III IIIIIIIIIIIIIIII FEB 19198T. <br /> MINED LAND <br /> LIMITED IMPACT OPERATION (110) RECLAMATION DIVISION <br /> APPLICATION FORM <br /> This form contains two maJor parts: (1) General Operation Information and (2) Exhibits <br /> A-G. When you submit your application, be sure to include two signed copies of the <br /> General Operation Information, two copies of Exhibits A-G, and Ta—cfwk for the <br /> application fee described under (4) below. To expedite processing, please provide the <br /> information in the format and order described in this form. <br /> sassaaaaaowmasaassaasasssmasaaasewsasaassmsaaowswwaosass s s o as aaw � <br /> GENERAL OPERATION INFORMATION <br /> Type or print clearly, in the space provided, all information described below. <br /> sssawaasssaaemsaarawwswmaaasasasaaammsmamwaa■asawaamssmwawsswaamsaaraaasawamasasaaaesmms <br /> 1. Applicant/Operator Name: __Cn]nraAn tlnwrrinz Tnr <br /> 2. Operation Name (Pit, mine or site name): Black obsidian <br /> 3. Application type: Limited Impact Operation (110). <br /> 4. Application Fee for Permitted Acreage* 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. clla_nn application fee. ! <br /> S. Substance(s) to be seined (e.g., gold/silver/gravel): <br /> 6. Owners(s) of Substance to be Mined <br /> (check applicable box(s)): 63 Private ❑ State ❑ Federal ❑ Indian <br /> 7. Owner(s) of Record of Affected Land <br /> (check applicable box(s)): 0 Private ❑ State ❑ Federal ❑ Indian <br /> S. Type of Mining Operation <br /> (check applicable box(s)): ® 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: <br /> PRINCIPLE MERIDI )T-(chect-c ones ❑ 6th (Colorado) ❑ 10th (New Mexico)❑ Ute <br /> TOWNSHIP (write number and check direction): T 22 ❑ North ® South <br /> RANGE (write number and check direction): R.'77 _ ❑ East 13 West <br /> SECTION (write number): S e <br /> QUARTER SECTION (check one): ❑ ® NW ❑ SE ❑ SW <br /> QUARTER/QUARTER SECTION (check one): CJ NE ❑ NW p SE ❑ SW <br /> GENERAL DESCRIPTION: <br /> (miles and direction _ ](nria) mils Nnrhh cif e, �fpe, r.n <br /> from nearest town and <br /> approximate elevation) E]aymj nn a_nnn <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 /> A-24 <br />