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:l ~C~C~VLD F~-x ~•• <br />\~ <br />~~ '~ ~ j 0 6 1995 <br />APPLICATION FORM <br />Division p,c~ <br />CHECK ONH: New Application (Rule 1.4.5) ~.quy+~pai(~iAa (Rule 1.10) <br />X Conversiaa Application (Rule 1.11) <br />Permit No. M- 87 _ 020 (provide for amendments and conversions of existing <br />permits) <br />The application for a Regular Operation Reclamation Permit contains three major parts: (1) <br />the application form; (2) Exhibits A-S and Geotechaical Stability Exhibit; and, (31 the <br />application fee. When you submit your application, be sure to include one (1) signed and <br />notarized original and four (4) copies of the application form, five (5) copies of fixhibits <br />A-R and nay required sections of Hxhibit S and the Geotechnical Stability Exhibit, and a <br />check for the application fee described under Section (16) oa Page 3. Hxhibits should not <br />be bound or in a 3-ring binder; maps should be folded to 8 1/2" X li" or 8 1/2" X 14" size. <br />To expedite processing, please provide the information in the format and order described <br />in this form. <br />GENBRAL OPERATION INFORMATION <br />Type or print clearly, in the apace provided, all information described below. <br />__'__~_____________________________________________°_________~====s=====_______________ <br />1. Applicant/operator or company name (name to be used on permit): <br />Rio Grande County <br />1.1 Type of organization (corporation, partnership, etc.): Government <br />2.2 I.R.S. Tax ID No- or Social Security Number <br />2. Operation. name (pit, mine or site Hamel: 3J4 Pit <br />3. Permitted acreage (new or existing site) 9.92 permitted acres <br /> 3.1 Change in acreage (+ or -) + 15.64 acres <br /> 3~.2 Total acreage in Permit area 25.56 acres <br />4. Fees: <br /> 4.1 New Application _;2.975.00 application fee <br /> 4.2 New Quarry Application 52.325.00 quarry application <br /> 4.3 Milling Application (Non-DMO) 53.100.00 milling application <br /> 4.4 Amendment Fee 51 .550.00 amendment fee <br /> 4.5 Conversion to 112 operation (set by statute) 51. 500.00 conversion fee <br />5. Primary commoditie(s) to be mined; Gravel Sand <br />6. Name of owner of surface of affected land: Rio Grande Coun ty <br />7. Name of owner of subsurface rights of affected land: Rio Grande County <br /> If 2 or more owners, refer to Exhibit 0. <br />8. Type of mining operation: R Surface IIndergrouad In-situ <br />9. Location Information: the center of the area where the majority of, mining will <br /> occur lies in: <br />COIIN2•Y: Rio Grande County <br /> PRINCIPAL MHRIDIAN (check one): ~" 6th (Colorado) ~ 10th (New Mexico) _ IIte <br /> SECTION (write nimiber) : S - 71 - <br /> TOWNSHIP (write number and check d i0 ~ North _ South <br /> RANGfi (write number and check direction): R ~ West <br />X fiast <br /> QLLDIRTER SfiCTION (check one): _ NH _ _ <br />NW }~ SS SW <br /> QOARTHR/QUARTER SHCTION (check one): Nfi NW X SH ~ SW <br /> GHNHRAL DHSCRIPTION (miles and direction £rom nearest town and approximate <br /> elevation); From the Tnwn of -el Norte• 1 mile north on C olo Hwv 112 then <br /> east 2 miles on County Road 7 North. Elevation at site is 7,850 <br />Q~~G~NAL <br />