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1 ~~CEiVE~ , <br />Xi <br />1 APR G 199 <br />MINED LAND <br />1 RECLAMA?!ON DIVISION <br />LIMITED IMPACT OPERATION (110(2)) <br />APPLICATION FORM <br />1 The Applicai;ton fora Limited Impact Operation Reclamation Permit contains three major <br />parts: (1) the Application Form, (2) the Application Exhibits A-F, and (3) the <br />application fee. When you submit your Application, be sure to include two si ned copies <br />' of the Appllcation Form, two copies of Exhibits A-F, and a check for the app rca on fee <br />described under (4) below. To expedite processing, please provide the information in <br />the format and order described in this form. ~-_~~,~1 Qa,,,,~~~~ ~ / <br />zecezzeaz:c::zszzzzxssz:czszzzeezeaaz=eeee.zezz_z zz azze•-v-~e i_ zzzxz `~fa~ee=z <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, all information described below. <br />zzzzzzzezcce:seezzzszazszzzzzszs:xsecsz:zeeeaczezee:eec:e:zzee~aeee:aczezsaecsz=zzezzzz:ze <br />1 1. Applicant/Operator Name: Central Citv Consolidated Piininn <br />2. Operation Name (Pit, mine or site name): rates-taunter [line <br />1 3. Appllcation type: Limited Impact Operation (110). <br />1 4. Application Fee for Permitted Acreage* ~_s permitted acres. <br />(S10 x (affected acres) + ;25.00).* <br />Note permitted acreage and application fee and <br />' attach a check for this amount when you file. So0.00 application fee. <br />5. Substance(s) to be mined (e.g., gold/silver/gravel): ~„i,,,c.;,,,p,. <br />' 6. Owners(s) of Substance to be Mined _ - - - <br />(check applicable box (s )): ~ Private State Federal Indian <br /> 7. Owner(s) of Record of Affected Land <br /> - - - - <br />(check applicable box (s )): a Private State Federal Indian <br /> 8. Type of Mining Operation <br />1 (check applicable box (s )): _ Surface ~ Underground _ In-situ <br /> 9. Location Information. The center of the area where the majority of mining will <br />' occur lies in: <br /> COUNTY: <br />PRINCIPLE c ec: one 6th (Colorado) 10th (New Mexico) Ute <br /> North ~ South <br />TOWNSHIP (write number and check direction): T 3 <br />- <br />' - <br />East ~ West <br />RANGE (write number and check direction): R ~~ <br /> SECTION (write number): S <br /> SW <br />NW ~ SE <br />QUARTER SECTION (check one): ~ <br />- <br />- <br />1 - <br />SW <br />NW SE <br />QUARTER/QUARTER SECTION (check one): ~ NE <br /> _ <br />GENERAL DESCRIPTION: <br /> (miles and direction Located between the towns of Central City <br /> from nearest town and <br /> approximate elevation) and Blackhawk at an elevation of 8,300 Feet <br />1 * If the operator is a unit of State or county government, an application fee is not <br />re <br />uir <br />tion of an acre must b <br />nt <br />d as one acre for fee calculation <br />d <br />A f <br />co <br /> q . <br />e <br />. <br />rac <br />e <br />u <br />e <br />1 <br />