REV01413

• Permit No: M1978072
• IBM Index Class Name: Revision
• Doc Date: 1/2/1996
• Doc Name: LIMITED IMPACT OPERATION RECLAMATION PERMIT APPLICATION FORM
• Type & Sequence: AM1
• Media Type: D
• Archive: No

EB `~ 19~~ R~~TTo t P'~Ei~T(11o c2)) ,IAN 0 2 1996
APPLICATION FORM rr==
C88CK ONB: J]iuiSid7eJt ~tBr,~;pt1,g(~Rule 1.4) ~ Amendment Application (C _~Ft!~54~~34y~F'!~JS1Y1`e~~~9Y
_~ Conversion Application (Rule 1.11)
Pezmit 4 M-~g_-~7~ (provide for amendments and conversions of
existing permits)
The application for a Limited Impact Mining Operation Reclamation Permit contains three major
parts: (1) the application form; (2) 8xhibits A-J, Addendum 1, nay sections of 8xhibit S and
Geoterhnical Stability s^xhfbit, as required by the Office, and outlined in Rules 6.1, 6.2,
6.3, 6.4.19 and 6.5; and (3) the application fee. When you submit your application, be sure
to include one (1) siaaed gad notarised original gad one (1) cropy of the application form,
two (2) copies of 8xhibits A-J, appropriate sections of 6.4.19 8xhibit S gad 6.5
(Geotecbaical Stability Exlaibit), as ~•;red, and a check for the application fee described
under (4) below. 8xhibits should not be bound or is a 3-ring binder; maps should be folded
to 8 i/2. 8 11• or 8 1/2" S 14" size. To expedite processing, please provide the information
in the format gad order described in this form.
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GENERAL OPBRATION IIQFORMATION
Type or print clearly, in the space provided, all information described below.
1:~- Applicant/operator or company name {name to be used oa permit):
1.1 Type o£ organization (corporation, partnership, etc.): rnva rnman+
1.2 I.R.S. Tax ID No, or Social Security Number:
2. Operation name (pit, mine or site name): Brent Pit
3. Permitted acreage (new or existing site): 1.75 permitted acres
3.1 Change in acreage (+ or -3 +7.30 acres
Total Acreage in Permit Area 9.07 acres
4. Fees:
4.1 New Application 5875.00 application fee
Amendment Fee (C.R.S. 34-32.5-125(II)) 5575.00 application fee
4.2 Conversion Fee (from 110d to 110 5875.00 conversion fee (Rule 1.11.2(2))
5. Primary oomrmditie(s) to be mined: Sand Gravel '
6. Name of owner of the subsurface rights of affected land: S . N _ RrPn t.
7. Name of owner of the surface of affected land: c u Aran +
8. Type of m;.,i.,g operation: _~ Surface Undergrvtmd In-situ
4. Location information. The center of the area where the majority of ~"++++++g will
occur lies in:
C01JN1'Y: T.i nrnt n Cnnn+.,~. Cnl nrad0
PRINCIPAL MHRIDIAN (check one): ~ 6th (Colorado) 10th (New M°rico) _ Dte
SECTION (write number): S 3(_
TOWNSHIP (write number and check direction): T ~_ North ~ South
RANGE (write number and check direction): R ~_ East X West
gdAR1'ER SECTION (check one): NE NW Sfi ~ SW
QOARTER/QiARTER SECTION (check one): ftE NW ~_ SE SW
RIPTION: (the number of miles and direction from the nearest town and
the approx~++~te elevation) wen Miles North and one mile west of Arriba,
('otnrado a~oroximately 5000 feet in elevation.