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III IIIIIIIIIIIIIIII ~ '~'-~,~~,,,~#~, LIMITED IMPACT OPERATION (110(2)) UfY 1 6 1992 RECLAMATION PERMIT Mlned Lind APPLICATION FORM RBNa^,,,+;,,,, ~. . The application fora Limited Impact Operation Reclamation Permit contains three major parts: (1) i:he application form; (2) Exhibits A-J; and, (3) the application fee. When you submit your application, be sure to include two (2) signed originals of the application i'orm, two (2) copies of Exhibits A-J, and a c'TieccT-for the application fee described under (3) below. To expedite processing, please pro ide th information in the format and order described in this form. ____=__==______________________________________ _ _ ___ _ _ -- -=G'_Y_J~1elJ ~- _ GENERAL OPERATION INFORMATION Type or print clearly, in the space provided, all information described below. 1. Applicant/operator name: xlown couNTY y~(~ ~~~-d 73 1.1 Type of organization (corporation, partnership, etC.): Local Government 2. Operation name (pit, mine or site name): FERRIS PIT 2.1 I.R.S. Tax ID No. or Social Security No.: 3. Application fee for permitted acreage* (525..00 + 10/acre)* Note permitted acreage and application fee and attach a check for this amount when you file. 9,g permitted acres application fee 4. Substance(s) to be mined (e.g., gravel/gold/borrow): Gravel 5. Name of owner of surface of affected land: Robert Ferr+s 6. Name of owner of subsurface rights of affected land: Roberc Ferris 7. Type of mining operation: xx Surface _ Underground i In-situ 8. Location information. The center of the area where the majority of mining will occur 1 i es i n: COUNTY: CHEYENNE PRINCIPAL MERIDIAN (check one): xx 6th (Colorado) 10th (New Mexico) Ute TOWNSHIP (write number and check direction): T ~ North '~~outh RANGE (write number and check direction): R ~` = East xx West SECTION (write number): S QUARTER SECTION (check one): ~ NW SE SW' QUARTER/QUARTER SECTION (check one): ~ NE xx NW ' SE _ SW GENERAL DESCRIPTION: (miles and direction From Haswell rto East on Hirzhwav 9 1 1/2 mil s from nearest town dnd turn North on C.R. 21 and go 12 1/2 miles, Turn approximate eleVdtiOn) East on Road BB and Qo 1 mile. Turn North 2 miles - then West 1/2 mile. * A fraction of an acre mist be counted as one acre for fee calculation. If the operator is a unit of state or county government, an application fee is not required.