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• ~` , •^ ~:~.{'~ ~ III III III III IIII III • <br />. i., Ir. _. .~ , <br />,~ 1 _, <br />~~ ~'i,l <br />1 11 <br />LIMITED IMPACT OPERATION (110(2)) <br />APPLICATION FORM <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 app-Tication fee <br />described under (4) 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 />-------------- <br />1, ppplieeint/Operator Name' San Miguel County Road Department <br />2. Operation Name (Pit, mine or site name): zadra Pit <br />3. Application type: Limited Impact Operation (110). <br />4. Applicz~tion Fee for Permitted Acreage* 9 permitted acres. <br /> Nn <br />(E10 x (affected acres) + 525.00).* <br /> Note permitted acreage and application fee and <br /> attach a check for this amount when you file. application fee. <br />5. Substance(s) to be mined (e. g., gold/silver/gravel): Gravel <br />6. Ownersls) 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 /> (che:ck applicable box (s )): x Private _ State _ Federal _ Indian <br />8. Type oi' Mining Operation <br /> (check applicable box (s )): x Surface _ Underground _ In-situ <br />9. Locatien Information. The center of the area where the majority of mining will <br /> occur lies in: <br />COUNTY: San Miguel <br />PRINCIPLE MERIDIAN c ec one 6th (Colorado) 10th QNew Mexico) Ute <br />TOWNSHIP (write number and check direction): T a3 x North South <br />RANGE (write number and check direction): R 12 -_ East x West <br />SECTION (write number): S 32 <br />QUARTER SECTION (check one): NE- x NW SE SW <br />QUARTER/QUARTER SECTION (check one): _ NE x NW _ SE _ SW <br />GENERAL DESCRIPTION: <br />(miles and direction 15 miles south of Norwood, CO. Blev. 9080 <br />from nearest town and <br />approximate elevation) <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 />