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, , ~~ ~ '~,~~ III III III III IIII III • <br />~u-~'O~S Jul REGULAR OPERATION (1 12 ) <br />i„ RECLAMATION PERMIT , <br />Rgc)an~" V ~ APPLICATION FORM <br />The application fora Regu lar Operation Reclamation Permit contains three major parts: <br />(1) the application form; (2) Exhibits A-S; and, (3) the application fee. When you <br />submit your application, be sure to include five (5) signed copies of the ,application <br />form five (5) copies of Exhibits A-S, and a check or a application fee described <br />under (3) below. To expedite processing, please provide the information i~~ the format <br />and order described in this form. <br />--- - ---------------------------------------------------------------------------------- <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, all information describ~ad below. <br />--------- - ----------- ----------------- ---------------- <br />1. Applicant/operator ndme: LeRov A. RellmnrP R % Fngona e.,or~ <br />1.1 Type of organization (corporation, partnership, etc.): Co-Owners <br />2. Operation name (pit, mine or Site name): (dba) North Weld Gravel <br />2.1 I.R.S. Ta ID No. or Social Secv rity No. <br /> <br />3. Application fee for permitted acreage* 80 permitted acres <br /> (550.00 + 515.00/acre, i st. 50 acres; <br /> 510.00/acre, 2nd. 50 acres; 55.00/acre, 3rd. 50 acres; <br /> 51.00/acre, any additional acreage; maximum fee of 52 ,000.00)* <br /> Note permitted acreage and application fee and <br /> attach a check for this amount when you file. N/A application fee <br />4. Substance(s) to be mined (e.g., gravel/gold/borrow): Gravels <br /> K. Eugene Ayers <br />5. Name of owner of surface of affected land+ LeRoy A. Bellmore <br />&: Name of owner of subsurface rights of affected land+ Union Facifi~: ^nailroad <br />7. Type of mining operation: x Surface _ Underground _ In-situ <br />8. Location Information: the center of the area where the majority of mining wiTi <br /> occur lies in: <br /> COUNTY: W~i~ <br />PRINCIPAL MERIDIAN (check one): ~ 6th (Colorado) 10th (New Mexico) Ute <br />~ <br />TOWNSHIP (write number and Check direction): T ~_ ~ North outti <br />RANGE (write number and check direction): R ~ East ~ West <br />SECTION (write number): ~ <br />S ~.~ i <br />QUARTER SECTION (check one): ~ NE NW SE SW <br />QUARTER/QUARTER SECTION (check one): X NE _ <br />_ <br />NW <br />x SE - <br />SW <br />GENERAL DESCRIPTION: _ <br />_ _ <br />(miles and direction 3 P7i1es Soutii and 3 Miles East <br />from nearest town and <br />approximate elevation) Nunn, Colorado EL= 5053 <br />* If the operator is a unit of state or county government, an application fee is not <br />required. A fraction of an acre nest be counted as one acre for fee calculation. <br />+ If 2 or more, refer o Exhibit P <br />