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• RF(`FI\~ n <br />Form 5310.1 <br />(mly t993) UNITED STATES ~ z ~ tg9 <br />DEPARTMENT OF THE INTERIOR <br />BUREAU OF LAND MANAGEMENT <br />FREE USE APPLICATION AND PERMIT Division of Mlnerais !~ GI <br />VEGETATIVE OR MINERAL MATERIAL <br />APPLJCATION <br />~)x,.,, <br />~. FORM APPROVED <br />OMH NO. 1004-0001 <br />Fnpirns: May 31, 1996 <br />Pcrmit Number COC-58780 <br />)10~,v <br />Expiration Date March 1 , 2001 <br />Duuim <br />Montrose <br />Name of applicant Address (include :ip code)P.O. BOX 572 <br />Ouray County <br />Ouray, CO 81427 <br />Kind of matcrial Gravel (Estimated quantity 225,000 GY <br />TOWNSHIP RANGE SECTION SUBDIVISION <br />T.45N„ R.BW., Sec. 3: E}NW}NW}, W}NE}NW}, W}E}NE}NW}, consisting of 18.4 acres as shown <br />on the attached map. <br />State of Colorado County at Ouray <br />Ma[erials are to be used for <br />maintainint; Ouray County roads. <br />I HEREBY AGREE TO COMPLY W ITH the special conditions az set (onh below. I CERTIFY That thc: (a) materials to bi removed art to be used (or tht purpose Doted <br />above; (b) none of the materials removed arc to be sold or bartered; (c) removal o(materials can begin only upon receipt o(an approved copy of this pcrmit; and, (d) the <br />authorizcd otittr is to be notJcd upon complc[ioo oC removal. <br />I CERTIFY That I am a citizcn of the Urtited States, and of the age of majority in [he Stale in which 1 reside. <br />! FURTHER CERTIFY That :he statements made by me to this application are true, complete, and concc: [o the best of my knowledgc and bchcf and art madc id good <br />faith. <br />i (Date) ($igaaturc o(Apphcant) <br />Title I B U.S.C. Section 1001, makes it a crime far my penov knowingly and willfully to make to any department or agency of the United Statc any false, fiaitiom, or (nudulevt rwemevu or <br />npmentauoos xs m any matter within ru jurisdinian. <br />PERMIT <br />SPECIAL CONDITONS <br />This permit is hereby issued for the materials applied (or but may be canttled if it appears that this permit was issued crroneously or the terms or condition containcd <br />hertin arc not observed. It shag be subject to the following spcciW conditions: <br />ATTACHED <br />aPPUCaer - r ~ ~~ .: <br />., il~ra,...t~f, <br />i:omervation practice must be tamed out az provided by47 CFR 3311.1-I(b), .2-7(c), The pttmittec shag clean up W work arras and shag remove or dtapose of aB refuse <br />and .J-3; restating from the permittte's opcratiom; <br />Equipment. pcnonN property, and improvementsmmr be removed within ninety (90) This permit is issued under the Am of JWy II, 1917, as amended, sad 43 U.S.C. and <br />days after expiration dart 43 CFR SS l 1.J-31; 1201, sad under the fra use privilege of the Art of May 14, 1898 (Aluka ody). <br />.4ny use of the surface of the Inds involved iv this permit sha0 be such as not to Anmatul rtpon indintingtheamouar(cu yds. orton)ofinetcrial removed ~OUr Ix <br />interfcre wvth any turning claim subjet[to the provision of Sectioo4of the AttotlWy Oiled with the Diann OlEtxan the atmiveraary date of the permit, or within rhiny(30) <br />23, ; 933 fl0 U.S.C. 613); days after permit expuvioo (Aiulw nary). <br />