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-2- R~ (112) PERMIT APPLICATION FORM 11. General Location and Elevation I T1S.R98W.Sec.27, NE '. (owrmit area li s within al larea within all f~~ir (miles ana direction from nearest town and a roximatc> quarter-quarter sections) Area is appoximately 25 air pp site elevation) miles southwest of Meeker, CO. Elevation is about 6,550 12. county Rio Blanco '3a Total Surface Acreage to be In- cluded in Permit. (see Rule Z1(2)) 37.1 acres 3b. Total Acreage of Affected Lands (see Rule 2.21(14)) 13.9 acres 14. Application Fee (see RULE 2 to 3620.00 determine amount, based on permitted area) 15. Present Land Use (i.e., agri- cultural, industrial, etc.) Rangeland, wildlife habitat, mineral activity l6. surrounding Land uses Rangeland, wildlife habitat, mineral activity 17. Proposed Future Land Use (final use after reclamation) Rangeland, wildlife habitat 18. List Mining Operations Currently None In Violation of the Act. (see 34-32-120) 19. The Lands Herein Do Not Affect The lands described b e d n ff any of the Lands Described in S ti 115 4 f f th Mi d desc ibed i Sec ~ 5 ec on ( )( ) o ne e Land Reclamation Act. (specify affirmation) MAPS AND EXHIBITS ft With each of the five (5) copies of the application form, the applicant must submit a correspond- ing set of the maps and exhibits outlined in RULE 2, as follows: 1 2 3 9 5 6 7 8 9 10 ll 12 13 14 Z5. I6. EXHIBIT A - Legal Description EXHIBIT B - Index Map EXHIBIT C - Pre-mining and Mining Plan Map(s) of Affected Lands EXHIBIT D - Mining Plan EXHIBIT E - Reclamation Plan EXHIBIT F - Reclamation Plan Map EXHIBIT G - Water Information EXHIBIT H - Wildlife Information EXHIBIT I - Soils Information EXHIBIT J - Vegetation Znfozmation EXHIBIT K - Climate EXHIBIT L - Reclamation Costs EXHIBIT M - Compliance with Local Zoning ) EXHIBIT N - Other Permits Or Licenses ) EXHIBIT O - Source of Legal Right to Enter ) EXHIBIT P - Owners of Record of Surface and Subsurface Rights) See 34-32-1I5(4)(e)& 109(6)&(8, See 34-32-115(4)&(4)(c) See 34-32-112(2)(d) See 34-32-112(2)(b)6(c)