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_ `/ <br />TWO-ACRE LIMITED 1 (110(1)) rah iZ 93 <br />RECLAMATION PERMI7 c.UTN pqq)( <br />APPLICATION FORM i. ~~~ ~~~c3 <br />i=r.~i~r~l~ <br />CHECK ONE: X New Application (Rule 3.3) Amendment App ~ tattoo CRule 1.8) <br />_ Conversion Application (Rule 1.10) qpR 1 6 1993 <br />The application for a Two-Acre Limited Impact Operation Reclamation Permit shall contain <br />three mayor parts: (1) the application form, (2) Exhibits A-I, art(fiv~63a~the~~appfii~c~'Ct~n <br />fee. When you submit your application, be sure to Include one (1) original sinned <br />application and one <1) copy cf the alp??t=tic.^. form, two (2) copies of Exhibits A-I, <br />and a check for the application fee described under (3) below. To expedite processing, <br />please provide the information in the format and order described in this form. <br />____=__°_________________________________________av=~==aa==aa====°_____==°==aac=ao===a.== <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the s;.ace.provided, all information described below. <br />===n.===_=vv====a=a as aaa=ova=ea==a=aaaaaeaa==-va==aaaaa==a=a:s=aao==noose=aaa=s==aa==noon <br />1. Applicant/operator name: John 0. Buckner <br />1.1 Type of organization (corporation, partnership, etc.) Sole Proprietor <br />2. Operation Name (pit, mine or site name): CRYSTALJACK (Mining operations) <br />2.1 IRS Tax ID No. or Social Security No.: <br />3. Permitted Acres: ''-•0 permitted acres <br />3.1 Application fee: (New Application Only) 5250.00 application fee <br />,...~-~----( ~ ~ ( ~~~;i„erg. - --Crystal mineral specimens <br />~~..,~o..~: s .o be mine„ e.,., ,ol ... .. <br />5. Name, addrzss, and phone number of the owner of the surface of the affected land: <br />U ~ Deot of sericulture Forest Service. Futh Park t)istr;rt anaPr ~7I°1 4;6-?0~1 <br />o. Name of owner of subsurface rights of affected lands:ti.s. Bureau of Land Management <br />7. Type of mintng operation: X Surface _ Underground _ In-situ <br />8. Location Information. The center of the area where the majcrity of mining will <br />occur lies tn: Teller <br />COUNTY: <br />PRINCIPAL MERIDIAN (check one): X 6th (Colorado) 10th (New Mexico) Ute <br />TOWNSHIP (write number and check direction): _ <br />T 11 North X South <br />RANGE (write number and check direction): R 71 _ East ~ Nest. <br />SECTION Cwrite number): 5 35 <br />QUARTER SECTION (check one): _ NE NW SE X• SW <br />QUARTER/QUARTER SECTION (check one): _ NE _ NW _ SE X SW <br />'ERA D RIPTION• <br />GcN L E$C Approx. N-31°-E, 4.92 miles from Lake George, CO <br />(miles and direction <br />from nearest town and <br />approximate elevation) 8.400 to 8.800 feet above sea level <br />