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x z • AUG 31988 ~ ~~ i TWO ACRE LIMITED IMPACT OPERATION (110(1)) RAIN E D LAND APPLICATION FORM RECLAMATION DIVISION The Application fora Two Acre Limited Impact Operation Reclamation Permit shall contain four major parts: (1) this Application Form, (2) Application Exhibits A-F, (3) an application 'fee, and (4) a financial warranty. When you submit your Application, be sure to include two signed copies of the Application Form, two copies of Application Exhibits A-F, a checcl-for the application fee described under (4) below, and a financial warranty for the required amount. To expedite processing, please provide the information to the format and order described in this form. GENERAL OPERATION INFORMATION Type or print clearly, in the space provided, all information described below. Appl icanl;/Operator Name: HARRY D. COVEY 2. Operation Name (pit, mine or site name): PHIL SHERIDAN LODE ~3. Application Type: Two Acre Limited Impact Operation (110(1)). {4. Application Fee for Permitted Acreage: ' Indicate permitted acreage and application 1.94 permitted acres. fee, (E10 x (affected acres) + E25)* and attach a check for this amount when you • ~ file your application. 545.00 application fee. 5. Substance(s) to be Mined (e.g., gold/silver): Au and Ag 6. Owner(s) of Substance(s) to be Mined (check applicable box(s)): x Private _ State _ Federal _ Indian 7. Owner(s) of Record of Affected Lands (check applicable box(s)): x Private _ State Federal _ Indian 8. Type of Mining Operation (check applicable box (s )): _ Surface x Underground _ In-situ 9. Location Information. The center of the area where the majority of mining will occur lies in: COUNTY: BOULDER PRINCIPE E c ec one): x 6th (Colorado) _ 10th (New Mexico) Ute TOWNSHIP (write number and check direction): T ~ X North South RANGE (write number and check direction): R ~ ~ East ~ West SECTION (write number): S QUARTER SECTION (check one): ~E- NW SE X SW QUARTER/QUARTER SECTION (check one): ~ NE . _ NW _ SE _ SW GENERAL DESCRIPTION: (miles and direction from nearest 6.2 miles Laest of Boulder at town and approximate elevation) ee e eva ion * A fraction of an acre must be counted as one acre for fee calculation. If the operator is a unit of state or county government, an application fee is not required.