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r ,~ <br /> <br />Ferm ssfaa . <br />(July 1993) <br />Name of applicant <br />UNITED STATES <br />DEPARTMENT OF THE INTERIOR <br />BUREAU OF LAND MANAGEMENT <br />FREE USE APPLICATION AND PERMIT <br />VEGETATIVE OR MINERAL MATERIAL <br />APPLICATION <br /> <br />Addren (incGrde zip mdc) P/,Z <br />PaRM AppnovED <br />OMB NO. ]U0a~1 <br />spires May 3l. 1996 <br />;'p - d/~ <br />~ Sao 2.~0,~ <br />Kind pC material ' ~ I Estimated quantity ~~ /Inn _ ~ <br />T09vNSHIP ~ RANGE ( SECTION ~ SUBDlVISfON <br />Tz5 /ozw /~ ~~E ~w <br />Stain of /i Couary of <br />~ /sue^0.~3 /`n ~/iy ~/ ~~/i /> <br />Materials tie ro be usM for ~^Qn ~ I A~ ~ _ <br />[HEREBY AGREE TO COMPLY WfiH the speck! wnditiona u set fonhhelow. 1 CERTIFY Ihu thc: (a) matciala to be removed are ro Oc wed ferthc purpose noted <br />abox; (b) none of the materials remoxd arc to be sold or bartered; (c) removal efmatarials can begin only upon receipt of>o approved Dopy otthis permit, and, (d) the <br />authorirM ofioer is w be notified upaa completion o[ removal. <br />I CER7IFY Thu I sin a ritiren of the Vaned State, and of nc~ age of majority in the Sate in which I rcide. <br />1 FURTHER CERTIFY That the stamments made by mr is the appliutioh arc true, complete, sod correct to the bat of my knowledge and bdirlaad are mace is good <br />faith. <br />i <br />-- _ (Dam) '~ (Signature of Appticaat) <br />Titl: IY U.S.C. Ssaion tOdl. make n a come for nay pmon Kno.inglY avd willfully W make w uY dep>MVent er ageery ofthe Urdted Ssarn nay fats Levrious, eefnuddenrstn<remts or <br />mpK3tat11llem is le my matter vrilhiv iV jaeidietlOL ~• <br />OFinaA1T .~ . <br />SPECIAL CONDITIONS - ~ ` <br />z^, . <br />Thv permit is hettby issuM for she materials applied for Dut may be naocled H i[ appears that this permri wu issued errorreotafy a;the [ermaar wnditiens watained <br />herein tie nos observed. It shall be subject to the follovring rpmal conditions: n <br />o`~-: ro <br />o-, <br />~U"~f]ijir.L' a ~ /~P'~v~,RG ~4Tji9c'!'~-ra `y'on ~- <br />c+- . <br />lu ~ (.. <br />L: <br />Ce-servatian practicer mrvr be carried our ar prov;dcd br+3 GFR 5511. I -I (h), , J(c), <br />and .J-?; <br />Equtpmem, personal property, and inprovemeots oust be removed vrithin oiaerY (90) <br />days afser eapuauoa dale 43 CFR SSl I.J-5); <br />.4aY use of fJte :uface of the laad> :m'oN'sd ip this Permit shall be such as nor to <br />interfere wish any mining claim subjss to the provistOns of Sssioa a of the Am of July <br />2J, 1955 (30 U.S.C. 61J); <br />The pmnirrtt aholl dean up all work areas and shall mroove ar dispose of >n du.e <br />resWtipg from rbe pcrmineeY operstiom; <br />This ycmtit it issued under she Aet of JWy 31. ] 9s7, as amended, and 47 U.S.C. and <br />1201, and uadtr the Its use privilege of rht Act of May l4, IY98 (Alaska Doty). <br />An amen! scportindimtiag the amount (tti yds. or tom) of material removed mtw Dc <br />filed with tpe Dis[tiet tXfice on theami.enary date of she permit, or wishia thcry (JO) <br />days after permit expvatioo (Aluka Daly). <br /> <br />