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llllllllllllllllll ~ ~ ~` ~ ~ ~~~ <br />RECEIVED <br />-- <br />LIMITHD IMPACP OPHRATION (110) <br />RHCI.ADSATION PHRMIT FEB 13 1995 <br />APPLICATION FORM <br />CHHCK ONH: X New Application (Rule 1.4) ~ Conversion r~~ipieralSSCae01pjy1) <br />Permit # M (provide for conversions of existing permits) <br />The application for a Limited impact Designated Mining Operation Reclamation Permit contains <br />three major parts: (1) the application form; (2) Hxhibits A-J, any required sections of <br />Hxhibit S and Geotechnical Stability Hxhibit, as required by the Office, and outlined in <br />Rules 6.1, 6.2, 6.3, 6.4.19 and 6.5; and (3) the application fee. When you submit your <br />application, be sure to include one (1) sinned and notarized original and one (1) copy of the <br />application form, two (2) copies of 8xhibite A-J, appropriate sections of 6.4.19 Hxhibit S <br />and 6.5 (Geotechnical Stability Hxhibit), ae required, and a check for the application fee <br />described under (4) below. Hxhibite should sot be bound or in a 3-ring binder; maps should <br />be folded to 8 1/2" X 11" or 8 1/2" X 14" size. To expedite processing, lease provide t e <br />information in the format and order described in this form. ~~~..~~~-~-~' f~ <br />GHNHRAL OPHRATION INFORMATION <br />Type or. print clearly, in the space provided, all information described below. <br />- -------- --- --- <br />1. Applicant/operator or company name (name to be used on permit): <br />CECIL C. POWELL <br />1.1 Type of organization (corporation, partnership, etc.): SOLE PROPRIETOR <br />1.2 I.R.S. Tax ID No. or Social Security Number: <br />2. Operation name (pit,~mine or site name): PO.WELL'S GRAVEL PIT <br />3. Permitted acreage anew or existing site): 9.99 permitted acres <br />3.1 Change in acreage (+ or -) O acres <br />4. Fees: <br />4.1 New Application ~ 5875.00 application fee <br />4.2 Conversion Fee (from 110d to 110 875.00 conversion fee (Rule 1.11.2(2)) <br />5. Primary commoditie(s) to be mined: GRAVEL SAND ROCK <br />6. Name of owner to the subsurface rights of affected land: ('F(~7T. ('. POWELL <br />7. Name of owner to the surface of affected land: CECIL C. POWELL <br />8. Type of mining operation: }~ Surface _ Underground _ In-situ <br />9. Location information. The center~of the area where the majority of mining will <br />occur lies in: <br />COpNTy; MOFFAT <br />PRINCIPAL MHRIDIAN (check one): ~ 6th (Colorado) ,T 10th (New Mexico) _ Ute . <br />SHCTION (write number): S _2 <br />TOWNSHIP (write number and check direction): T ~_ X North_ South <br />RANCH (write number and check direction): R 10'1 _ Hast W West <br />QDARTBR SfiCTION (check oae): ~ NB _ NW _ SH _ SW <br />QUARTHR/QIIARTHR SECTION (check one): _ NH _ NW ~ SH _ SW <br />GHNHRAL DHSCRIPTION: (miles and direction from nearest town and appr <br /> ation) APPROXIMATELY 4 MILES EAST OF DINOSAUR <br />10. Correspondence Information: ~ )) <br />APPLICANT/OPHRATOR (name, address, and phone of name to be used on POWN1ER <br />Contact's Name: CECIL C. POWELL Title: <br />Company Name: <br />Street: P • 0. HOX <br />City: D N , <br />State: COLORADO Zip Code: 816I0 <br />Area Code: 303 Telephone: 374- 2329 <br />ORIGINAL <br />