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. ' II'll'IIIIIII~~~~~ • OCT 16199 I 999 DIV a~Ui4 LIMITED IMPACT OPERATION (110(2)) MINERALSBiiEU~='~'` RECLAMATION PERMIT APPLICATION FORM The application for a Limited Impact Operation Reclamation Permit contains three major parts: (1) the application form; (2> Exhibits A-J; and, (3) the application fee. When you submit your application, be sure to include two (2) signed originals of the application form, two (2> copies of Exhibits A-J, and a check for the application fee described under (3> below. To expedite processing, please provide the information in the format and order described in this form. M -C~-_ ~i~ GENERAL OPERATION INFORMATION Type or print clearly, in the space provided, all information described below. 1. Applicant/operator name: CITY OF MONTE VISTA 1.1 Type Of organization (corporation, partnership, etC.): LOCAL GOVERNMENT 2. Operation name (pit, mine Or Site ndme): LAGOON PIT 2.'I I.R.S. Tax ID No. or Social Security No.: 3. Permitted acreage 6 permitted acres 3.'I Application Fee $875.00 application fee 4. Substance(s) to be mined (e.g., gravel/gold/borrow): cRAVeL 5. Name of owner of surface of affected land: clTr of MONTE VISTA 6. Name of owner of subsurface rights of affected land: clTy of MONTE v1sTA 7. Type of mining operation: xx Surface _ Underground _ In-situ 8. Location information. The center of the area where the majority of mining will occur lies in: COUNTY: RIO GRANDE PRINCIPAL MERIDIAN (check one>: _ 6th (Colorado) xx 10th (New Mexico) _ Ute TOWNSHIP (write number and check direction): T 39 xx North _ South RANGE (write number and check direction): R a xx East _ West SECTION (write number): S 32. QUARTER SECTION (check one): _ NE T NW _ SE xx. SW QUARTER/QUARTER SECTION (check one): _ NE tXX, NW _ SE _ SW~ GENERAL DESCRIPTION: (miles and direction Approximately one mile northeast of Monte from nearest town and approximate elevation) Vista. Approximate elevation: 7650'