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<br />III III III III IIII III ~rnr,\/C (~ <br />~LL ~ L1 jUl]ti, <br />REGULAR OPERATION (112) <br />RECLAMATION PERMIT <br />APPLICATION FORM ilrvw~c„ :, ,:~ ~ ~ „,, .. -.., <br />lication for a Regular Operation Reclamation Permit contains three major parts: <br />application form; (2) Exhibits A-S; and, (31 the application fee. When you <br />your application, be sure to include five (5) signed copies of the application <br />flue (5) copies of Exhibits A-S, and a check or a application fee described <br />• (3) below. To expedite processing, please provide the nf~rmation in the format <br />order described in this form. .may/ ~s~7aS~~~_ ~, f~J(~_'_-_--, <br />=zzzaaaazazoaa~=za=~=-•" GENERAL OPERATION INFORMATION ~S! <br />Type or print clearly, in the space provided, all information described below, <br />.s zzazzazzazzazazzazaaaaaazzazzaazazzezzazaasaazezzazvazaaaea=azazazssava~evzea=vve-veza <br />I . Applicant/operator name: S„ ~, ~ ~ ., c hr l'~„~ f. . ! ,, ~ D~~ll• <br />1.1 Type of organization {corporation, partnership, etc.?: ~r yc,, /1 ,1 ~,•,~ r <br />2. Operation name (pit, mine or site name): (~~ /r ;, ,,, ,:~ ! <br />2.1 I.R.S. Tax ID No. or Social Security No.: <br />3. Application fee for permitted acreage* e,-,•; permitted acres <br />(550.00 + 515.00/acre, 1st. 50 acres; <br />510.00/acre, 2nd. 50 acres; 55.00/acre, 3rd. 50 acres; <br />51 .DO/acre, any additional acreage; maximum fee of 52 ,000.00)* <br />Note permitted acreage and application fee and <br />attach a check for this amount when you file. ~'/ ~~-:.:,, application fee <br />4. Substance(s) to be mined (e.g., gravel/gold/borrow): ., _, ,,~) , „-~,~., I ,...;1 C~6~/e <br />5. Name of owner of surface of affected land+ c~,~„~.;i,~ ~,.,,,1, <br />6. Name of owner of subsurface rights of affected land+ ~,,.,,,,,, ;, ,_ <br />_T - - <br />~. 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: Sc,,~i,la r i~c <br />PRINCIPAL MERIDIAN (check one): 6th (Colorado) x 10th (New Mexico) Ute <br />TOWNSHIP (write number and check direction): T 4r/ ~ North mouth <br />RANGE (write number and check direction): R ~ ~ East _ West <br />SECTION (write number): S ' <br />QUARTER SECTION (check one): ~ NE _ Nw SE SW <br />QUARTER/QUARTER SECTION (check one): NE _ NW _- SE `'y SW <br />GENERAL DESCRIPTION: <br />(miles and direction `~ .1 ,,, /P. •;,-, ~ , „-..f •; .,s,,,,~ ~ r C.. <br />from nearest town and <br />approximate elevation) = L ~ „• ~ ,. ~_/; <br />rr <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 />+ If 2 or more, refer to Exhibit P <br />