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III IIIIIIIIIIIII III <br />999 <br />• <br />LIMITED IMPACT OPERATION (110) <br />APPLICATION FORM <br />~ECEI'VED <br />JUN 011981 ~ a ~1 <br />MINED LAND <br />RECLAMATION DIVISION <br />This form contains two major parts: (1) General Operation Information and (2) Exhibits <br />A-G. Wlien you submit your application, be sure to include two signed copies of the <br />General Operation Information, two copies of Exhibits A-G, and a c e k for the <br />application fee described under (4) below. To expedite processing, please provide the <br />information in the format and order described in this form. ~, ~ ~ _Cf <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, all information described below. <br />1. Applicant/Operator Name: coNE~os COUNTY <br />2. Operation Name (Pit, mine Or Site name): LA FLORIDA GRAVEL PIT <br />3. Application type: Limited Impact Operation (110). <br />4. Application Fee for Permitted Acreage* ~ <br />permitted acres. <br /> (E10 x (affected acres) + E25.00).* _ <br /> Note permitted acreage and application fee and <br /> attach a check for this amount when you file. /~l ~ application fee. <br />5. Substance(s) to be mined (e. g., gold/silver/gravel): r.RAVet. <br />6. Owners(s) of Substance to be Mined `/ <br /> (check applicable box(s)): ® Private $~ <br />/` State ^ Federal ^ Indian <br />7. Owner(s) of Record of Affected Land <br /> (check applicable box(s)): D Private ^ State ^ Federal ^ Indian <br />8. Type of Mining Operation <br /> (check applicable box(s)): f1 Surface ^ Underground ^ In-situ <br />9. Location Information. The center of the area where the majority of mining will <br /> occur lies in: <br />COUNTY: coNe~os <br />PRINCIPLE MERIDIAN check one ^ 5th (Colorado) ® 10th (New Mexico)^ Ute <br />TOWNSHIP (write number and check direction): T <br />~ ® North ^ South <br />RANGE (write number and check direction): - <br />_ <br />R ~ ® East ^ West <br />SECTION (write number): _ <br />S <br />QUARTER SECTION (check one): ®~ ^ NW ^ SE ^ SW <br />QUARTER/QUARTER SECTION (check one): ® NE ^ NlJ ^ SE ^ SW <br />GENERAL DESCRIPTION: <br />(miles and direction s% miles SE of Antonito, Col orado <br />from nearest town and <br />approximate elevation) <br />* If the operator is a unit of State or county government, an application fee is not <br />required. A fraction of an acre must be counted as one acre for fee calculation. <br />