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.• _ <br />I~ I~~~IIII~11~11~~ <br />999 <br />JUC 51984 <br />LIMITED IMPACT OPERATION (110(2)) L~'''`='~.r,~.,,, <br />APPLICATION FORM ~" '"~c., <br />~~; ~:~ , . <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 sigg~ned copies <br />of the Application Form, two copies of Exhibits A-F, and a check for the appTicafion fee <br />described under (4) below. To expedite processing, please provide the information in <br />the format and order described in this form. ~ _c~ ~ <br />_______________________________________________________________~______=~=~=G ~ ? ________ <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, all information described below. <br />----------------------------------------------------------------------------------------- <br />----------------------------------------------------------------------------------------- <br />1. Applicant/Operator Name: wpsx~NC~rox coutv'rY <br />2. Operation Name (Pit, mine or site name): ivICkELL GRAVEL °I 1• <br />3. Application type: Limited Impact Operation (110). <br />4. Application Fee for Permitted Acreage* 8.51 Permitted acres. <br />(;10 x (affected acres) f ;25.00).* <br />Note permitted acreage and application fee and <br />attach a check for this amount when you file. N/p application fee. <br />5. Substance(s) to be mined (e.g., gold/silver/gravel): <br />6. Owners (s) of Substance to be Mined <br />(check applicable box (s )): g 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: laashinQton <br />(miles and direction ;, ;,o~ Cn."rh ..a ~ ; ~o ..{ ... ~•ti~....,, <br />from nearest town and - co. <br />approximate elevation) <br />PRINCIPLE ER D A c ec one 6th (Colorado) 10th (New Mexico) Ute <br />TOWNSHIP (write number and check directio n): T ~_ North ~ South <br />RANGE (write nu mber and check direction): R ~ _ East ~ West <br />SECTION (write number): _ <br />S <br />~ <br />QUARTER SECTION (check one): NW ,~ SE SW <br />QUARTER/QUARTER SECTION (check one): NE SE _ SW <br />~ NW <br />GENERAL DESCRIP TION: _ _ <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 />