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sss • ~ ,~ ~ <br />LIMITED IMPACT OPERATION.(110(2)) _~ <br />RECLAMATION PERMIT ~YVrn ~}.ro <br />APPLIGTION fORM ~ ~ ~~-~ <br />~ 3v:3 • `i~rY-~I4y <br />CHECK ONE: ~ Ner Application (Rule 3.2) Amendment Application (Rule 1.8) <br />_ Conversion Application (Rule 1.10) <br />The application for a Limited Impact Operation Reclamation Permit contains three mayor <br />parts: (1) the application form; (2> Exhibit.; A-J; and, (3) the application Fee. Nhen <br />you submit your application, be sure to inclwle one <1) Signed original and one (1) copy <br />of the application form, two (2) copies of Exhibits A-J, and a check for the application <br />fee described under (3) below. To expedite p~•ocessing, please provide the information <br />to the format and order described in this foro+. <br />raarrarraraaraaaaaaraaraaaaa~raraaaaaaraafaar~~araasaaaaaaaaaraaraaraaraaraaraaaeaaaaaaaar <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, all information described below. <br />sarrrrasaaafaaraaaaaaaraarraaaraaaaraarlraa~aaaaaaaaaaraaaaaaaa aarasaarasaaraaaaaaaaaaaaa <br />1. Applicant/operator name: 1~A6N1?~t C~arsr. Par.. <br />1.1 Type of organization (corporation, pirtnershlp, etc.): ~.'oe~ora~ie N <br />2. Operation name (pit, mine or site name): ,~ ma co ec b <br />2.1 I.R.S. Tax ID No. or Social Security No.: ®~F~13T8l1~ _ <br />3. Permitted acreage 9~f~~~?~ permitted acres <br />3.1 Application Fee (Ner Application On1~~) 5875.00 application fee <br />4. Substance(s) to be mined (e.g., gravel/gold/borrow): n~~2ee~[ <br />5. Name of owner of surface of affected land: h~lLB j3i~lsuR <br />6. Name of owner of subsurface rights of affected land: S)IIME. <br />7. Type of mining operation: ~, Surface _, Underground _ In-situ <br />e. Location information. The center of the ar~!a where the ma~Orlty of mining will <br />occur lies in: <br />COUNTY: <br />PRINCIPAL MERIDIAN (check one): 6th +Colorado) <br />TOWNSNIP (write number and check dir~tion>: T <br />RANGE (write number and check direction): R g,p_ <br />SECTION (write number); 5 ~ <br />QUARTER SECTION (check one): ~, NE <br />QUARTER/QUARTER SECTION (check one): _ NE <br />GENERAL DESCRIPTION <br />IOth (Ner Mexico) Ute <br />North South <br />_ East ~, Nest <br />Cen~R ~ ~• iD SN <br />_ NN ~ SE _ SN <br />(miles and direction ~~~/ri~~iT~y ~j~,d~delyr.r~'~f~r' <br />from nearest torn and <br />approximate elevation) >f.•rtr ter{-. 9 w s~ ;1dA~ <br />IO 'd ZL6E bV6 EOE 'ON Xdd '9,LW O4d80'100 ,ISBI~ Wd OZ:EO NOW 66-9Z-lQf <br />