Laserfiche WebLink
1 ~--gal ... <br />"' <br />~ <br /> . <br />.. <br />-- <br />ry <br />r- <br /> Form 5510-I ~ ~ FORM APPROVED <br /> (March 1988) UNITED STATES OMB N <br />O <br />~ <br />~ <br />9 <br />b <br /> <br />DEPARTMENT OF THE INTERIOR E <br />G <br />cr <br />91 <br />. <br />90 <br />o <br />' <br />BUREAU OF LAND MANAGEMENT permit Number <br /> COC-52699 <br /> FREE USE APPLICATION AND PERMIT Expiration Datc <br /> VEGETATIVE OR MINERAL MATERIAL Aril 1 199b <br />' Distfict _ <br /> APPLICATION ~ ~Montrose~ <br /> Name ofapplicant Address (include zip code) <br />' Ouray County, Colorado PO Box C, Our.a_a, Colorado 81427 <br /> Kind of material Sand and Graeel ~ Estimated quantity20, 000 ydS/yEar <br />' Give legal land description <br /> TOWNSHIP RANGE SECTION SUBDI`/ISION <br /> <br />' i ~ <br />T.45N., R.8W.;-'.Brae: 3, E~NW}NW} a;i3 WkNE~NW}, NMPM ~ .... <br /> State of, Colorado County oC Ouray ~. ~ - <br />' Materials are to be used (or <br /> _a ~,:, ...t mot., ~.~ ~a <br /> 1 HEREBY AGREE TO COMPLY W ITH the special conditions az set forth below. I CERTIFY That the: (a) materials to be removed are to be used for the purpose noted <br /> 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 ehis permit; and, (d)the <br />' authorized officer is to be notified upon completion ofremoval. <br />' 1 CERTIFY That 1 am a citizen of the United States, and of the age of majority in the Stale in which 1 reside. <br />1 FURTHER CERTIFY That the statements made by me in this application are trot, rompletc, and correct to the best o(my knowledge and belief and are made in good <br />' faith. <br />/-~ <br />i--. <br />(Date) (Signature of Applicant) <br />Title I B 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 States any false, fictitious, or fraudulent statements or <br />representations as to any matter within i¢jurisdiction. <br />' PEAMlT <br />SPECIAL CONDITIONS <br />This permit is hereby issued for the materials applied (or but may be canceled if it appears that this permit waz issued erroneously or the tSrms or conditions Contained <br />herein are not observed. It shall be subject to the (ollowmg special conditions: <br />' :sTTIaCNED <br /> ]nformation is collected to comply with Statutes (16 U.S.C. 604fi06 and agency R egulations (43 CFR 5511.1-I(f)). <br /> Information is used to confirm the residence of the applicant. <br />' Applicant must respond to obtain a permit. <br /> Conservation practices must be carried out as provided by d3 CFR 551 I.1-I(b)..2-3(c), The p<rmittee shall clean up all work area and shall remove or dispose of all refuse <br />' and .3-3: resulting from the permitted operations: <br /> Equipment, personal property, and improvements must be removed within ninety(90) This permit is issued and<rth<Actofluly 31, 1947,uamend<d, and 4)U.S.C. and <br /> days after expiration date d7 CFR 5511.3-5); 1201, and under the free use privilege of the Act of May 14, 1898 (Alazka only). <br /> Any use of the surface of the lands invoh'ed in this permit shall be such az not to An annual report indicming theamount (cu. yds. or tons)of ma¢rial removed must b< <br />f <br />h <br />i <br />i <br />hi <br />h <br />30 <br />' interfere with any mining claim subject to the provisions of Section4 of the Act ofluly e perm <br />t <br />t, or w <br />t <br />n r <br />ir/v / <br />) <br />Bled with th<District Ofhce on the anniversary date o <br /> 23, 1955 (JO U.S.C. 613); days after permit expiration (Alaska only). ~ <br />~~ cff <br /> <br /> <br /> :. <br />~~yy <br />r <br />,: <br />, <br /> (Dam) (Signature o(Authorixed Officeq <br /> <br />