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~ ~ III IIIIIIIIIIIIIIII ~ ~ ~~~~~~F~® <br />' ~ ~ OCT 0 9 199Q <br />Mined Lance <br />' LIMITED IMPACT OPERATION (110(2) ) Reclamation Division <br />APPLICATION FORM <br />' The Application fora Limited Impact Operation Reclamation Permit contains three major <br />parts: (1) the Application Form, (2) the Application Exhibits A-F, and (3) the <br />application fee. When you submit your Application, be sure to include two s~iggne~d copies <br />of the Application Form, two copies of Exhibits A-F, and a check for the appTic'~ion fee <br />' described under (4) below. To expedite processing, please provide the information in <br />the format and order described in this form. (Yl 3 ( 3 ~ < <br />___________________________________________________`-~~ ==1== ~____ ~___=___ ___________ <br />1 GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, all information described below. <br />' 1. Applicant/Operator Name: James H, f: Kathleen H. °,oss <br /> 2. Operation Name (Pit, mine or site name): Ross nit <br /> 3. Application type: Limited Impact Operation (110). <br /> 4. Application Fee for Permitted Acreage* °.52 permitted acres. <br /> (E10 x (affected acres) + 525.00),* <br /> Note permitted acreage and application fee and <br /> attach a check for this amount when you file. ^130.20 application fee. <br />' S. Substance(s) to be mined (e.g., gold/silver/gravel): Travel <br /> 6. Owners(s) of Substance to be Mined <br />t - - - - <br />(check applicable box(s)): x Private State Federal Indian <br /> 7. Owner(s) of Record of Affected Land <br />' (check applicable box(s)): x Private _ State _ Federal _ Indian <br /> 8. Type of Mining Operation <br />' (check applicable box (s )): x 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: 'Moffat <br /> PRINCIPLE ERIDI N c ec one 6th (Colorado) 10th (New Mexico) Ute <br /> TOWNSHIP (write number and check direction): T 6 x North _ South <br />- <br />' East x West <br />RANGE (write number and check direction): R ~~ <br /> SECTION (write number): S 3 <br /> ~- x NW <br />SE <br />SW <br />QUARTER SECTION (check one): <br /> - <br />_ <br />_ <br />QUARTER/QUARTER SECTION (check one): x NE NW x SE x SW <br /> GENERAL DESCRIPTION: a portion of the SF3,I~F3;, S~•1~DIE3;, ivT~~~3; of Sec. .3, "'6T1, °90[•i <br /> (miles and direction 5 nil_ec Fact of rYaio Cnlo_ <br /> from nearest town and <br /> approximate elevation) h200 fr_ <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 /> 1 <br />