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,- OMB No. 0596--0092 • Expires 9/30/86 USDA-Forest Service FORES RVICE USE ONLY SPECIAL•USE APPLICATION AND REPORT Date Received (mo/day/yr) Region Number State code county code (Ref.: FSM 2712, 36 CFR 251.54) Q ~/ 2~/$ ~ ~ 2 ~ ~ ~'L~ Congressional Forest Code Unit ID Symbol INSTRUCTIONS Dist. Number (Atlmin. Unit NoJ (NFFIp NoJ Applicant should request a meeting with the Forest ~ ~ ~ 9 Q ~ Q 1 Service representative responsible for processing the application, prior to completing this form. This meeting Ranger Dist. No. User Number Kind of Use Code well allow a discussion of the torm's requirements and (Reap. Dist.) identify those items to be omitted. BOtLVW 04 1015 Pit 420 PART I-APPLICATION (Applicant Completes) 1. Applicant Name and Address 2. Authorized Agent Name, Title and Address (in~ 3. Area Code and Telephone (include Zip Code) dude Zip Code) if different from Item 1. Number Mineral County ~zrd of CaralLissioners a. Applicant's Nellie M. Ydyley 303-658-2331 Cha117nan b. Authorized Agent's 303-658-2.360 4. As applicant are you? (Mark one box with "X") 5. Specify what application is for: (Mark one box with "X") a. ~ Individual a. ® New authorization' b. ~ Corporation' b. ~ Renew existing authorization c. ~ Partnership/Association' c. ~ Amend existing authorization° d. ~ State Government/State Agency d. ~ Other' e. ®Local Government • If marked ••x'•, provide details under Item 7. f. ~ Federal Agenty ' It marked "X", complete PART II. 6. If you are an intlividual or partnership, are you also a citizen(s) of the United States? Yes ~ No NfA 7. Describe in detail the land use, including: (a) type of use. activity, or facility; (b) related structures and facilities; (c) physical speci~ fications (length, width. acres, etc.); (d) term of years needed; (e) time of year of use or operation; (f) duration and timing of con struction; (g) temporary work areas needed for construction; and (h) anticipated need for future expansion. (I( extra space is neetl ed, use Page 3, REMARKS). The use herein applied for is a gravel borrcx.7 pit to be used to furnish surfacing material for county road maintenance. The only related structures associated with the use will be temporal.) in nature. Crushing equipment would be brought in to crush rock periodically as needed and then be removed upon completion of the crushing operations. The pernlit ar requested is 6n0' in length a 300' in width x 15' iii depth or any agreeable dimension equalling 180,000 sq. ft.. surface area or approximately 4 acres. This would yield approximately 135,000 tons of gravel. Request a. 10 year Term Permit. The use of the crushed rock would occur from spring through fall each year for approximately six to eight rmnths. No construction will occur other than crushing the gravel from the permitted area and stockpiling it on the permitted area. It may be reasonably assumed that at sane point in the future (12 to 15 years) that expansion of the permitted area may be necessary. 8. Attach map covering area and show location of proposed use and/~or lurnish legal description of the land. TO be attached at the time the area is surveyed and laid out on the ground. 9. Give statemen[ of your technical and financial capability to construct, operate, and terminate the use for which authorization is requested, including the protection and restoration of Federal lands. (If extra space is needed, use page 3, REMARKS). As a local government entity we have the financial capability to operate and te~•rlinate such a use. F7e have budgeted money for the gravel pit. The county has the necessary equipment for loading and hauling gravel and for rehabilitation. The borraa pit will be operated and rehabilitated to T'orest Service specifications to minimize any adverse environmenal impacts. Previous etlition is obsolete. (OVER) F6-2700.3 (10/93)