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i ~ <br />• • <br />III III III III IIII III <br />LIMITED 999_ __. ;110(2)) <br />RECLAMATION PERMIT <br />APPLICATION FORM <br />The application for a Limited Impact Operation Reclamation Permit contains three major <br />parts: (1) the application form: (2) Exhibits A-J: and, f3) the application fee. When <br />you submit your application, be sure to include two (2) signed originals of the <br />application form, two (21 copies of Exhibits A-J, and a cTiecTc for the application fee <br />described under (3) below. To expedite processing, please provide the information in <br />the format and order described in this form. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, all information described below. <br />1. Applicant/operator name: Lincoln County <br />1.1 Type of organization (corporation, partnership, etc.): County Gov't. <br />2. Operation name (pit, mine or site name): Ravenkamp Pit #~1 <br />2.1 I.R.S. Tax ID No, or Social Security No.: <br />3. Application fee for permitted acreage* N/A permitted acres <br />Note permitted acreage and application fee and <br />attach a check for this amount when you file. N/A application fee <br />4. Substance(s) to be mined (e. g., gravel/gold/borrow): Gravel <br />5. Name of owner of surface of affected land: Ravenkamp Farms. Inc. <br />6. Name of owner of subsurface rights of affected land: Ravenkamp Farms, Inc. <br />7. Type of mining operation: 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: Li ncol n <br />(miles and direction Five Miles west of Hugo, CO on correction <br />from nearest town and <br />approximate elevation) line road, then two miles south. El. 5320 <br />PRINCIPAL MERIDIAN (check one): X 6th (Colorado) 10th (New Mexico) Ute <br />TOWNSHIP (write number and check direction): T 11 North S Scuth <br />RANGE (write number and check direction): R ~ - East W West <br />SECTION (write number): S ~ <br />QUARTER SECTION (check one): ~1E NW X SE SW <br />QUARTER/QUARTER SECTION (check one): _ <br />X- NE NW SE - SW <br />GENERAI DESCRIPTION: <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 />