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IMITHD III III III IIIIIIIIII (110) ~ 1l 1995 R ggg APPLICATlUfI rViua ne~a15&Geo~o9Y CHHCK ONH: X New Application (Rule 1.4) Conversion 1~y,514~~t on (Rule 1.11) Permit # M (provide for conversions of existing permits) The application for a Limited Impact Designated Mining Operation Reclamation Permit contains three major parts: (1) the application form; (2) Hxhibits A-J, any required sections of Hxhibit S and Geotechnical Stability Exhibit, as required by the Office, and outlined in Rules 6.1, 6.2, 6.3, 6.4.19 and 6.5; and (3) the application fee. When you submit your application, be sure to include one (1) sinned and notarized original and one (1) copy of the application form, two (2) copies of Hxhibits A-J, appropriate sections of 6.4.19 Hxhibit S and 6.5 (Geotechnical Stability Exhibit), as required, and a check for the application fee described under (4) below. Exhibits should not be bound or in a 3-ring binder; maps should be folded to 8 1/2" X 11^ or 8 1/2" X 14• size. To expedite processing, please provide the information in the format and order described in this form_--- ~_ 9S ~~ ------------------------------------- _____________________________________________________ GHNHRAL OPHRATION INFORMATION Type or print clearly, in the space provided, all information described below. ________________________________________________________________ -- ------------------------- 1. Applicant/operator or company name (name to be used on permit): Park County Road and Bridge 1.1 Type of organization (corporation, partnership, etc.): Government 1.2 I.R.S. Tax ID No. or Social Security Number: 2. Operation name (pit, mine or site name): (Siaparral Pit 3. Permitted acreage (new or existing site): 9.9 permitted acres 3.1 Change in acreage (+ or -) acres 4. Fees: 4.1 New Application ~ 5875.00 application fee 4.2 Conversion Fee (from 110d to 110 875.00 conversion fee (Rule 1.11.2(2)) 5. Primary commoditie(s) to be mined: Pit run '~f 6. Name of owner to the subsurface rights of affected land: Park County 7. Name of owner to the surface of affected land: Park County e. Type of mining operation: X Surface _ Onderground _ In-situ 9. Location information. .The center of the area where the majority of mining will occur lies in: Park COON'PY PRINCIPAL MHRIDIAN (check one): _ 6th (Colorado) 10th (New Mexico) _ Dte SHCTION (write number): S ~ TOWNSHIP (write number and check direction): T 13 _ North X So ite number and c2~eck direction) : ~ R ~_ _ Hast - X west QIITaRTHR SHCTION (check one): _ NH ~ NW _ SH _ SW QLTARTBR/QIIARTHR SHCTION (check one): _ NH _ NW _ SH ~ SW GHNSRAL DHSCRI PTION• (miles and dire tion fr nears t own and roxia~te elevation) The P1£ is approx 20 tulles sout~east o~ tie taan o~Hartsel. C~,h~ra_rral is aonrox 8.700 feet ah-we sea level __ 10. Correspondence Information: APPLICANT/OPHRATOR (name, address, and phone of name to be used on permit) Contact's Name: Rick Peters Title:A"`S15tant COOICI]S]at0r Company Name: Park County Road and Bridcxe Street: 1246 County Road 16 City: Fairplay State: C'nlnrarln Zip Code: Rflddfl Area Code: 719 Telephone: 83Fi-277 1 FSrt 777 o~~G~N~~ ~~ ~,~- ~3~- y ~~