PERMFILE67701

• Permit No: M1978007
• IBM Index Class Name: Permit File
• Doc Name: SOIL & VEGETATIVE INVENTORIES FOR GRAVEL PITS
• Media Type: D
• Archive: No

Form ssto-1 / ,' ~ UNITED STATES
(January 1979) DEPARTMENT OF THE INTERIOR
BUREAU OF LAND MA~JAGEMENT
a N
FREE USE APPLICATION AND PERMIT
VEGETATIVE OR MINERAL MATERIAL
APPLICATION
Name of applicant
Address (include zip code)
Moffat Count Road De t. P.O. Box 667, Crai CO 81625
Kind of material Estimated quantity
Pit Run or Crushed Rock 100 000 Cu. Yds.
Give legal land description
TOWNSHIP RANGE sECTrnN cnonnne,riv
11N. lO1W. 28 & 33 Sec. 28, SEr, SW; SW; Sec. 33, N? NW; NW;
S%= SE; SW; NW; NE; NW;
State of (County of
Colorado Moffat
Materials are to be used for
Surfacing on County Roads.
1 HEREBY AGREE TO COMPLY R'ITH the special conditions as set forth below. 1 CERTIFY That the: (a) materials
to be removed are to be used for the purpose noted above; (b) none of the materials removed are to be sold or bartered;
(c) removal of materials can begin only upon receipt of an approved copy of this permit; and, (d) the authorized officer
is to be notified upon completion of removal.
1 CERTIFY That I am twenty-one years of age or older, a citizen of the United States, and resident of the State of
1 FURTHER CERTIFY That the statements made by me in this application are true, complete, and correct to the best
of my knowledge and belief and are made in good faith.
(Date) ,T- (Signal of
Title 18 U.S.C. Section 1001, makes it a crime for any person knowingly and willfully to make to any department or agency of the
United Steles any (else, fictitious, or fraudulent statements or representations as to any matter within its jurisdiction.
PERMIT
SPECIAL CONDITIONS
This permit is hereby issued for the materials applied for but may be canceled if it appears that this permit was
issued erroneously orlhe terms or conditions contained herein are not observed. It shall be subject [o the following
special conditions:
(See attached sheet).
Consen~ation practices must be carried out as provided
by 43 CFR SS11.1-I(b), .2-3(c), and .3-3;
Equipment, personal property, and improvements must
be removed within ninety (90) days after expiration
date (43 CFR 3621.4(c) or 5511.3-5);
Any use of the surface of the lands involved in this
permit shall be such as not to interfere with any mining
claim subject to the provisions of Section 4 of the Act
of Jul}• 23, 105 (30 U.S.C. 613);
~ /~~ /its
(Det c)
The permitlee shall clean up all work areas and shall
remove or dispose of atl refuse resulting from the
perm ittee's operations;
This permit is issued under the Acl of July 31, 1947, as
amended, and 43 U.S.C. and 1201, and under the free use
privilege of the Act of May 14, 1898 (Alaska).
An annual report indicating the amount (cu. yds. or tons)
of material removed must be filed with the Dis-
trict Office on the anniversary date o[ the permit, or
within thirty (30) days-a{tr\permit expiration.

I
l ~ ~ ~ ~ •~ ~
FORM APPROVED
OMB NO. 42-R0875
Yermll rvumcer
05010 -75 - 5
Exprration Date
, .~
ature of Aulhorizetl Officer)
DISTRICT OFFICE