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,~~ : ~ , • - -= .. ~ ~ iii iiiiiiiiiiiu iii <br />~ Fa/m 5510-t UNITED STATES <br />(October 1975) DEPARTMENT OF THE iNTERfOR OMB NOp 7R R0875 <br />i <br />BUREAU OF LAND MANAGEMENT permll Number _i <br />+ ~. ~ <br />i <br />FREE USE APPLICATION AND PERMIT Expvallon Dale~~ <br />VEGETATIVE OR MINERAL MATERIAL Dletrlct <br />~ APPLICATION °'' <br />i Name of applicant Address (include zip code) <br />fiuray Cotutty Bin C, Ouray, Colorado 81427 I <br />Kind of materiel Estimated quantity <br />Gravel ~'i ~;i~.' ° <br />~'j Give legal lend description ~1 ~ ~ <br />r{ TONNSHIP RANGE SECTION SUBDIVISION <br />; <br />i <br />T. 45N R. 8 W. Sec. 3 Ey:, NlJ',t., NWJ6 <br />T. 45N R. 8 ltl. Sec. 3 Wyz, NE;6, Mdy6 <br />-'~ Area consists of 39.87 acres, more or less, northeasterly 3.6~ miles '• <br />from the Town of Ridlnfay. <br />Materials ere to be used for <br />Roads and related work i <br />I HEREBY AGREE TO COMPLY WITH the special conditions es set forth below. I CERTIFY That the: (a) materials, ~ ' sv ' <br />to be removed ere to be used for the purpose noted above; (b) none of the materiels removed ere to be sold or bartered; <br />(c) removal o[ materiels can begin only upon receipt of en approved copy of this permit; end, (d) the authorized officer ' <br />is to be notified upon completion of removal. I <br />li <br />-~~ .. 1 <br />I CERTIFY Thet I em twenty-one years of age or older, a citizen of the United States, end resident of the State of ~ ~ <br />i <br />~~_~11~ ~ - I FURTHER CERTIFY Thet the statements made by me in this application ere true, complete, end correct to the best i <br />', r~ of my knowledge end belief end ere made.in good faith. <br />•~~ COUNTY OF OURAY ^' <br />.. ~.. <br />September 3, 1976 BY:.' ' <br />(Date) ~ ~ ~ (Si~rlelure of Applieen0 ; <br />Title 18 U.S.C. Section 1001, makes It a crime for any person knowingly end willfully to make ~to any department or agency of the I <br />United States sny (else, fictitious, or fraudulent statements or representstlona as to any matter wlthln Its )urlsdlclion. <br />.f~ PERMIT ~. .. , <br />I _ <br />~!~ - SPECIAL CON DITlONS ._ .. <br />This permit is hereby issued for ,the materiels applied for but may be. canceled iE .it appears that this permit was ; <br />issued erroneously or the terms.or.cordi4oa~ coataingd herein are not observed. It shall be subject to the following <br />special conditions: ~•, , .. , . _ ,r :, .._ , <br />See atiTC c;:' mining plan.,ald~.specia', stinu;iabiQns.,,.., .:.: ,;::. <br />f, .... <br />F , . ... .:,~....:t.• .. r,. ... . , .. , <br />'I ! ,.. . <br />1rI <br />' ilr,a::..: .:~. 5siti <br />