REV101935

• Permit No: M1990016
• IBM Index Class Name: Revision
• Doc Date: 12/4/1992
• Doc Name: LIMITED IMPACT OPERATION 110 2 APPLICATION FORM
• Type & Sequence: AM1
• Media Type: D
• Archive: No

r ,
pEG ~ 1992
LItdITED IMPACT OPERATION (110(2))
APPLICATION FORM Un!5~.~"
riINERAi.6 h .~i_~li_~.~~„
The Application fora Limited Impact Operation Reclamation Permit contains three major
' parts: (1) the Application Form, (2) the Application Exhibits A-F, and (3) the
application fee. When you submit your Application, be sure to include two signed copies
of the Application Form, two copies of Exhibits A-F, and a check for the application fee
' described under (4) below. Ta expedite processing, please provide the information in
the format and order described in this form.
-----------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------
- GENERAL OPERATION INFORMATION
Type or print clearly, in the space provided, all inforination described below.
1. Applicant/Operator Name: high Plains Stone Co.
2. Operation Name (Pit, mine or site name): Sontl, 40 Quarry
3. Application type: Limited Impact Operation (110).
4. Application Fee for Permitted Acreage*
I$10 x (affected acres) + £~5.00).* 9.8 permitted acres.
Note permitted acreage and application fee and
attach a check for this amount when you file. $125.00 application fee.
5 b
ta
c
) to be
ed (
old/silver/
rav
l):
s
(
i l
t~
`
. g
u
s
n
e
s
m
n
e.g., g
e c
.ace Ptoss
oc
Sur,
6. Owners(s) of Substance to be hiined
(check applicable box(s)): _ Private X State ~ Federal _ Indian
7. Owner(s) of Record of Affected Land

(check applicable box(s)): -
Private X -
State ~ Federal
Indian
8. Type of Mining Operation
e (check applicable box (s )): g Surface _ Underground _ In-situ
9. Location Information. The center o f the area where t he majority of mining will
occur lies in:
COUNTY: Fremont
PRINCIPLE ER DIA c ec one g 6th (Colora do) 10th (New Mexico) Ute
T06JilSNIP (write number and che ck direction): T 17 _ North ~r South
RAIJGE (write number and check direction): R East X
68 West
SECTION (write number): S _
14 + t5 i
QUARTER SECTION (check one): X -AE- ~ NW
SE SW
' QIIARTER/QUARTER SECTION (check one): NE NW SE SlJ
GENERAL DESCRIPTIOtJ: -
-
(miles and direction 15 miles 1I1; of Penrose on Colo Hwy 115
from nearest town and
approximate elevation) 6800 feet above sea level
* If the operator is a unit of State or county government, an application fee is not
required. A fraction of an acre must be counted as one acre for fee calculation.
uF`-4