PERMFILE61132

• Permit No: M1987164
• IBM Index Class Name: Permit File
• Doc Date: 10/16/1987
• Doc Name: LIMITED IMPACT OPERATION 110 APPLICATION FORM
• Media Type: D
• Archive: No

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LIMITED IMPACT OPERATION (110}
APPLICATION FORM
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This form contains two major parts: (1) General Operation Information and (2.) Exhibits
A-G. When you submit your application, be sure to include two s~iggne~d copies of the
General Operation Information, two copies of Exhibits A-G, and as Ct~k for the
application fee described under (4) below. To expedite processing, please provide th ~,
information in the format and order described in this form. p//{./. ~7 ~ ~,Ksy/~/r~/a7S.~?>~
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GENERAL OPERATION INFORMATION
Type or print clearly, in the space provided, all information described below.
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1. Applicant/Operator Name: James E, Camilletti
2, Operation Name (Pit, mine or site name): Camilletti Pit

3. Application type: Limited Impact Operation (110).
4. Application Fee for Permitted Acreage* n,~ permitted acres.
(b10 x (affected acres) + 525.00},*
Note permitted acreage and application fee and
attach a check for this amount when you file. :'125.00 application fee.

5. Substance(s) to be mined (e. g., gold/silver/gravel): sand arl cl gravel

6. Owners(s) of Substance to be Mined
(check applicable box(s)): ^ Private ^ State ^ Federal ^ Indian
7. Owner(s) of Record of Affected Land
(check applicable box(s)): CI Private ^ State ^ Federal ^ Indian
8. Type of Mining Operation
(check applicable box(s)): t~ Surface ^ Underground ^ In-situ
9. Location Information. The center of the area where the majority of mining will
occur lies in:
COUNTY: P,outt
PRINCIPLE MER 0 AN chec one 67.<5th (Colorado} ^ 10th (New Mexico)^ Ute
TOWNSHIP (write number and check direction): 7 6 >p XNOrth ^ South
RANGE (write number and check direction): R gg ^ East ~ West
SECTION (write number): 5 11
QUARTER SECTION (check one): ~~- ^ NW ^ SE ^ SW
QUARTERlQUARTER SECTION (check one): ~ NE ^ NW ^ SE ^ SW
GENERAL DESCRIPTION:
(miles and direction 1', miles east of Ha,Vden
from nearest town and
approximate elevation) approx. 64~!0~ ASL
* If the operator 1s a unit of State or county government, an application fee is not
required. A fraction of an acre must be counted as one acre for fee calculation.
2