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<br />• III IIII IIIII IIII III ~ ~_ ., _, ; :. ` _,. , {, ~ ~_ <br />yip . ~.: , <br />OCT ~ 11987 <br />LIMITED IMPACT OPERATION (110) <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 sig~n--e--d copies of the <br />General Operation Information, two copies of Exhibits A-G, and ask 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 />GENERAL OPERATION INFORMATION ~lS U~ <br />Type or print clearly, in the space provided, all information described below. <br />1. Applicant/Operator Name: ~ OS T ~ ICI t U/G" S TN OF ~ <br />2. Operation Name (Pit, mine or site name): ~~ Ste'/,(0 fi F ~!~ l2M S . <br />'• 3. Application type: Limited Impact Operation (110). fit ~ E <br />~ 4. Application Fee for Permitted Acreage* ~_permitted acres. <br />(E10 x (affected acres) + E25.00).* <br />Note permitted acreage and application fee and O ~ <br />attach a check for this amount when you file. 7 ~,- application fee. <br />5. Substance(s) to be mined (e. g., gold/silver/gravel): ~~ ~ 'f' <br />6. Owners(s) of Substance to be Mined <br />(check applicable box(s)): ~{ Private ^ State ^ Federal ^ Indian <br />7. Owner(s) of Record of Affected Land <br />(check applicable box(s)): ~ Private ^ State ^ Federal ^ Indian <br />8. 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: ~ 0 ri' fr'A /U <br />PRINCIPLE MERIDIAN check one ~ 6th (Colorado) ^ 10th (New Mexico)^ Ute <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 />TOWNSHIP (write number and check irection): T ® tJorth ^ South <br />RANGE (write number and check direction): R ^ East ,(~ West <br />SECTION (write number): S <br />QUARTER SECTION (check one): ^ ^ NW ~ SE ^ SW <br />QUARTER/QUARTER SECTION (check one): ^ NE ^ NW SE ^ SW <br />GENERAL DESCRIPTION: <br />(miles and direction ~~ M I1-£5 SOOT ~J °f ~ m ~~ l,Ur~"~" <br />from nearest town and U <br />approximate elevation) 0~ GV ~6G~n- S C1 J _--l7 0 b f-r - <br /> <br />