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~ ~~ III IIIIIIIIIIIIIIII ~ <br />999 RFC <br />LIMITED IMPACT OPERATION (110(2) F~~/~C <br />RECLAMATION PERMIT <br />APPLICATION FORM 0%SO/ R ~Q 19 <br />The application for a Limited Impact Operation Reclamation~~Rep~/~ co ~ ains three major <br />parts: Cl) the application form; (2) Exhibits A-J; and, (3) the ~~bication fee. When <br />' you submit your application, be sure to include two (2) signed origin~'~'s of the <br />application form, two (2) copies of Exhibits A-J, and a check for the application fee <br />described under (3> below. To expedite processing, please provide the information in <br />' the format and order described in this form. J O g <br />---------------------- <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, all information described below. <br />1. Applicant/operator name: BACA COUNTY BOARD OF COUNTY COMMISSIONERS <br />1.1 Type of organization (corporation, partnership, etc.): covNTY <br />' 2. Operation name (pit, mine Or Slte ndme): MUNDELL ESTATE GRAVEL PIT 1132 <br />2.1 I.R.S. Tax ID No. or Social Security No.: <br />3. Permitted acreage 9.12 permitted acres ~~ <br />3.1 Application Fee 5875.00 application fee <br />t 4. Substance(s) to be mined (e.g., gravel/gold/borrow): GRAVEL <br />MAMIE MUNDELL IRREVOCABLE TRUST <br />5. Name of owner of surface of affected land: JANE MUNDELL. TRUSTEE <br />MAMIE MUNDELL IRREVOCABLE TRUST <br />6. Name Of owner of subsurface rights of affected land: JANE MUNDELL. TRUSTEE <br />' 7. 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: BACA <br />' PRINCIPAL t4ERIDIAN (check one): x 6th (Colorado) 10th (New Mexico> _ Ute <br />TOWNSHIP (write number and check direction): T 3o North X South <br />RANGE (write number and check direction): R 42 _ East X West <br />SECTION (write number): S 3 <br />QUARTER SECTION (check one>: x NE = NW - SE = SW <br />QUARTER/QUARTER SECTION (check one): NE NW ~ SE SW <br />GENERAL DESCRIPTION: <br />(miles and direction APPROXIMATELY I1 MILES NORTHEAST OF WALSH, COLORADO <br />from nearest town and <br />approximate elevation) <br />1 <br />~ ORICaINAL <br />1 <br />