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99 <br />-4- <br />RHGQLAR OPHRATION (112) <br />RHCLAMATION PHRMIT <br />APPLICATION FORM <br />CHHCK ONE: ~ New Application (Rule 1.4.5) <br />Conversion Application (Rule 1.11) <br />• <br />R3 <br />R~rFIVFD <br />FEB 0 6 1995 <br />Amendment Application (Rule 1.10) <br />Divisu ~~~ u. ~~unerais s neology <br />Permit # M 9'1 - f191 (provide for amendments and conversions of existing <br />permits) <br />The application for a Regular Operation Reclamation Permit contains three major parts: (1) <br />the application form; (2) Hxhibite A-S and Geotechnical Stability Hxhibit; and, (3) the <br />application fee. When you submit your application, be sure to include one (1) signed and <br />notarized original and four (4) copies of the application form, five (5) copies of Hxhibits <br />A-R and any required sections of Hxhibit S and the Geotechnical Stability fixhibit, and a <br />check for the application fee described under Section (16) on Page 3. Hxhibite should not <br />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. <br />To expedite processing, please provide the information in the format and order described in <br />this form. ~~, <br />------------- ------ <br />GHNHRAL OPHRATION INFORMATION <br />Type or print clearly, in the apace provided, all information described below. <br />1. Applicant/operator name: Fisher Sand 8 Gravel Co. <br /> <br /> 1.1 Type of organization (corporation, partnership, etc.): orpnratinn <br /> <br /> 1.2 I.R.S. Tax I.D. No.: 45-O'i0R5R1 <br />2. Operation name (pit, mine or site name): Fosse Pit <br /> <br />3. Permitted acreage (new or existing Bite) 20 permitted acres <br /> 3.1 Change in acreage (+ or -) 0 acres <br /> 3.2 Total acreage in Permit area 20 aCCeB <br />4. Fees: <br /> 4.1 New Application 51.875. 00 application fee <br /> 4.2 New Quarry Application 52.325.00 quarry application <br /> 4.3 Milling Application (Non-DMO) 53.100.00 milling application <br /> 4.4 Amendment Fee 51.550.00 amendment fee <br /> 4.5 Conversion to 112 operation (set by statute) S1.500 .00 conversion fee <br />5. Primary commoditie(s) to be mined: Sanri (;ravel Rnrrnw <br /> <br />6. Name of owner of surface of affected land: FuAana R Adrienn e Fasse <br />7. Name of owner of subsurface rights of affected land: Eugene & Adrienne Fasse <br /> if 2 or more owners, refer to Hxhibit 0. <br />S. Type of mining operation: ~ Surface IInderground <br />9. Location Information: the center of the area where the majority of mining will occur <br /> lies in: <br /> CODNTY : JSi t C a r s o n <br />PRINCIPAL MERIDIAN (check one): ~ 6th (Colorado) 10th (New Mexico) _ Dte <br />SHCTION (write number): S <br />TOWNSHIP (write number and check direction): T North ~ South <br />RANGH (write number and check direction): R - Hast ~ West <br />QIIARTER SHCTION (check one): x NH xx NW _ SE _ SW <br />QDARTHR/QIIARTER SHCTION (check one): xx NH X NW SH SW <br />GHNHRAL DHSCRIPTION (miles and direction from nearest town and approximate elevation): <br />A ~nrnximatel~r 7 milers Fact of Riirlin8tnn~ fnlnradn <br />Elevation aogroximately 4500 feet. <br />ORIGINAL <br />