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• ~II II~II~II~~I~~ ~I~ <br />sss <br /> <br /> <br /> <br />~' ~~V 1 U 1988 <br />LIMITED IMPACT OPERATION (110) <br />APPLICATION FORM <br />~'c:;!_:~' ~!:', ICS' tJ;vr.:'.t7e~~ <br />This form contains two major parts: (1) General Operation Information and (2) Exhibits <br />A-G. When you submit your application, be sure to include two ~~si nam~ed copies of the <br />General Operation Information, two copies of Exhibits A-G, and a~eCk for the <br />application fee described under (4) below. To expedite processing, please provide the <br />information in the format and order described in this form. _ _ ' <br />---------------------------------------------- - <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, all information described below. <br />1. Applicant/Operator Name: Kit Carson County <br />2. Operation Name (Pit, mine or site name): Ostrowski Pit <br />3. Application type: Limited Impact Operation (110). <br />4. Application Fee for Permitted Acreage* 9.4 permitted acres. <br /> ($10 x (affected acres) + $25.00).* <br /> Note permitted acreage and application fee and <br /> attach a check for this amount when you file. NA application fee. <br />5. Substance(s) to be mined (e. g., gold/silver/gravel): Road Gravel <br />6. Owners(s) of Substance to be Mined <br /> (check applicable box(s)): ® Private ^ State ^ Federal ^ Indian <br />7. Owner(s) of Record of Affected Land <br /> (check applicable box(s)): ^ Private ^ State ^ Federal ^ Indian <br />8. Type of Mining Operation <br /> (check applicable box(s)): ® Surface ^ Underground ^ In-situ <br />9. Location Information. The center of the area where t he majority of mining will <br /> occur lies in: <br />COUNTY: hit Carson <br />PRINCIPLE MERIDIAN check one ~ ^ 6th (Colorado) ^ 10th (New Mexic~^ Ute <br />* If the operator is a unit of State or county government, an application fee is not <br />required. A fraction of an acre must be counted as one acre for fee calculation. <br />TOWNSHIP (write number and check direction): T 6 ^ North South <br />RANGE (write number and check direction): R ~- ^ East ® West <br />SECTION (write number): S '~- <br />QUARTER SECTION (check one): ^~-NNW ^ SE ^ SW <br />QUARTER/QUARTER SECTION (check one): ^ NE ® NIJ ^ SE "~$W <br />GENERAL DESCRIPTION: ' <br />(miles and direction 16 Miles North & 5 Miles west of F1aRer, <br />from nearest town and <br />approximate elevation) Approx. Elevation 4600' <br />