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-2- R~ (112) PERMIT APPLICATION FORM 11. General Location and Elevation ( Approximately 1'~ miles S.W. of Fountain, Colorado (miles and direction from i Elevation 5,600' nearest town and approx mate site elevation) 12. County El Paso County 13a. Total Surface Acreage to be In- cluded in Permit. (see Rule L 1(2) 373 (284) acre amendment 13b. Total Acreage of Affected Lands (see Rule 2.12(14)) 373 (284) acre amendment 14. Application Fee (see RULE 2 to 84?.. 00 determine amount, based on permitted area) Present Land Use (i.e., agri- cultural, industrial, etc.) Agricultural I6. Surrounding Land Uses Agricultural 17. Proposed Future Land Use (final use after reclamation) Agricultural - Grazing 18. List Mining Operations Currently None Zn Violation of the Act. (see 34-32-120) 19. The Lands Herein Do Not Affect Affirmative they do not any of the Lands Described in effective described land in Section 115 (4) (f) Section 125(4)(f) of the Mined Land Reclamation Act. (specify affirmation) MAPS AND EXHIBITS ~th each of the five (5) rnpies of the application form, the applicant must submit a correspond- ing set of the maps and exhibits outlined in RULE 2, as follows: 1. EXHIBIT A - Legal Description 2. EXHIBIT B - Index Map 3. EXHIBIT C - Pre-mining and Mining Phan Map(s) of Affected Lands 4. EXHIBIT D - Mining Plan 5. EXHIBIT E - Reclamation Plan 6. EXHIBIT F - Reclamation Plan Map 7. EXHIBIT G - Water Information 8. EXHIBIT H - Wildlife Information 9. EXHIBIT Z - Soils Information 10. EXHIBIT J - Vegetation Information 11. EXHIBIT K - Climate 12. EXHIBIT L - Reclamation Costs Z3. EXXIBIT M - Compliance with Local Zoning ) EXHIBIT N - Other Permits or Licenses ) EXHIBIT O - Source of Legal Right to Enter ) ~ 16. EXHIBIT P - Owners of Record of Surface and S ubsurface Rights) See 34-32-I15(4)(e)6109(6)s(8) See 34-32-115(4)6(4)(c) See 34-32-I12(2)(d) See 34-32-112(2)(b)s(c)