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Form 3310.1 • ~ FORM APPROVED
<br />(May 1983) UNITED STATES OMB NO. 1004-0001
<br />DEPARTMENT OF THE INTERIOR Expires: October 31, 1987
<br />BUREAU OF LAND MANAGEMENT Permit Numbcr
<br />CO-050-RG-FU=90-13
<br />FREE USE APPLICATION AND PERMIT Expiration Dete
<br />VEGETATIVE OR MINERAL MATERIAL Oct. 1 1993
<br />District
<br />APPLICATION CO-050
<br />Name of applicsnt '~emdh"€)"~`d1Qnf~) Courthouse ~
<br />Fremont Count Canon Cit CO 81212
<br />KiM of material ~ Estimated quantify
<br />Gravel
<br />Give legal land description
<br />TOWNSHIP RANGE SECTION SUBDIVISION I
<br />49 N. 11 E. 2 NE}NE}
<br />~; +.ay iLir cisiw JUl.'
<br />I,. :L„u<c.:u Ipie lcd m.a p .~' ~go:vi i. (1 t-1[1111 P1 L"1777 tpc lcdmcrlr w• (•.. ip~; ~iPaV:.~i „ml.n :,r.rl (nl
<br />$lete of µip lw.4 w~ x..^ pc n ..:~ ,r.: .Ir o}.,~~~:_rrw(z County O(
<br />Colorado Fremont
<br />Materials arc to be used for I,•.. • •lwr•.,r ~ •v1 r cs: r' a•r ; m'ar.ul gc6l~e~o~' r. .~ ~ ' • ~ . • .~ v"la' .
<br />Countv ftoaa Maintenance ~ ~
<br />' t'. a</ H..,7i r~. 1, r: l i:l 41 " 1 '~ L' l~1~ nl' eCd'1 p nnlu.. n. ~ u,• .i.. n.n ~,.vt '.
<br />1 HEREBY AGREE TO COMPLY WITH the apenM conditibns a9 te(lor~ll flow. t'CERTIFY That the: (e) materiels to bt removed arc to be used for the purpose Doted
<br />above; (b) none of the materiels removed arc to be sold or bartered; (c) removal of materials can begin only upon receipt ofnn approved copy of Chia permit; and, (d) the
<br />authorized officer u to be noti(red.upomcompktion oLrompvaL~ ...n., ~ '
<br />ELFE(:J OL NO1 bUO;dUivh'69tOklWV110(I-II~'w qo ear (uwi'1'al,lp•.nr .aw el. tu.. t.u.:.ipu '~ ,
<br />1 CERTIFY Thar I am a citizen of the'Unired'Stieei;'tl+rd'oPth'k e)ke of majority in the State in which I reside. . ~ A
<br />;,rclt r;aluluw v. cpol n..9 a.np cupnuuR,o miLlr.mtul )uL 1N, •r. u' ~' i• '' .. ^Imo' a~. , ~•i pruuzc
<br />n.pcq:~t begetn;'rlvi:'~neal otlule•hu'cpnlxe~Mip tpe u...,e •qu~u ~, :car .a4n i•.e ~. '.i a,cnq'nY
<br />I FURTHER CERTIFY Thu lht sterovirnu'midrby dt! iuthh ap'plltitidiJ ire'6fiftl,'lBhiplete;lehd'COr4eti to'thC beer ofm3'khOw~edgf~end belief sad arc made in good
<br />faith. ''e' Iuuaa.r.d rPG U,.dl 9tuevwyrrvtq urm;pno4m no. c...•y.i,.~..~ ~ ~ .u,..':.ar.,~. ,,. iq.'
<br />' InallGt lrt lpC Klnlgl.
<br />tai ttaurgcto tpa t.i Oct.vWamm 4t'pi;lacw tyc arc4l '+Ur(!Lunc,~m, .: nx ,~¢lnc,aq• ice. ,ny,o-cr ~
<br />Lnul'r. l:Wyr of rcro n.r c> //q ~~~/~
<br />.~ -~/3//9pD~~l Ini uzLcc In cLh u;Lumc Isgctal xdcur.mr np,:u Cuuldµ;.w ~~~(r• ~'L~%O~"LI~.C.(~~ .
<br />~- ,.(Date)wcur yi.. ..,~ ,eq err. i., Unpp• ~+uqz xutl s:raur.::• 1144 (Signsturc of Applicant)
<br />Tilk IB U.S.C. Section 1001, makes it •crime (or any penoh taowinsly find willfully ro make to any department or agency of the United Siatea any falu,fictitious, or fnudulenl adtemenu or
<br />rtarraeatlllOOlYln aaY matter witAia in llJrLtd1e1i06ur.e .. .. ...b.n -car. iL,.. ~n hm ter', .n ~ .ui.i
<br />uc.rl u.le r2E2. PERMIT ~
<br />btlINC•raVf e(ItlbOcC ' 1 Pc wpu wsu SPECIAL coNdtiaNS •~ .~~ .~~': ~ '~•~, ,~.' ,:' I u.c , lam'
<br />This permit is hereby issued for.thq matirids~ppliedior buhmay tee eppxled.d it appear that this permit wu issued erroneously or the term+or coaditiom tomaiaed
<br />herein arc not observed. It sha116e subject to the following spmel conditions:
<br />1. Soil Conserva'ti'tin''Serv3;FgG'Retaamh'tYon"Plafi'kt5f"'oth'er approved plan will be utilized.
<br />2. Trees along th'e 'southern boundary of the permit area will ~be prat;erveti.
<br />3. Highwalla are not authorized. Final contours,will be maintained during the thine life.
<br />,til Lll,t
<br />Information is collected to comply with Statutes (16 U.S.C. 604fi06 end agency Regulations (dl CFR 351 I.I-I(~).
<br />Itiformuion is used to warm the rcsidrna of the applicant.
<br />Applicant mart respond to obtain a permit. ~
<br />Conservation practices mitt! be carried out as provided by 43 CFR 331 I.I-I(b), I The permillee shall clean up ell work areas and shall remove or dispose of all
<br />.2-3(c), end .3-3; refuse resulting from the permittee's operations;
<br />Equipment, personal properly, and improvements must bt removed within
<br />ninety (90) days after expiration date 43 CFR 3311.3-3);
<br />Any use of [hc surface o(the lands involved in this Permit shall be such as nor Io
<br />interfere with any mining claim subject to the provisions of Section 4 0(the Acl of
<br />July 23, 1933 (30 U,S.C. 613);
<br />3,
<br />This permit is issued under the Acl of July J I, 1947, as amended, and 43 U.S.C
<br />and 1201, end under the free use privilege of lht Ae[ of.Mey Id, 1898 (Alaska)
<br />An annual report indicating the amount (cu. yds. or tone) of materiel removed
<br />muss be filed wish the District Office on the ennivenitry date of the permit, or
<br />within thirty (30) days after permit expiration.
<br />_ie~-~-
<br />,r
<br />(Signature of Authorized Officer)
<br />aPPUCaNT
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