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i~• <br />~~~ ~~~~~~~~~~~~~ ~~~ AU ~; 9 19®9 <br />sss M7lvEp LArvU <br />RECLAMATIpN DIVi!~~ <br />LIMITED IMPACT OPERATION (110(2)) <br />APPLICATION FOR14 <br />The Application fora Limited Impact Operation Reclamation Permit contains three major <br />parts: (1) Uie 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 Application Form, two copies of Exhibits A-F, and a check for the app rca ion fee <br />described under (4) below. Ta expedite processing, please provide the information in <br />the format and order described in this form. ~~_ 8~_ S <br />------- ----- ----- ------------------------- <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, all information described below. <br />3 - <br />1. Applicant%Operdtor Name: Fremont Connty Board of Cnnnr~ r~mm,~~;.,.,a,-~ <br />2. Operation Name (Pit, mine or site name): nak rra a4 r.,-~.,a, p;r (Ynrkvilla1 <br />3. Application type: Limited Impact Operation {110). <br />4. Application Fee for Permitted Acreage* q_~ ± permitted acres. <br /> (E10 x (affected acres) + ;25.00).* <br /> Note permitted acreage and application fee and <br /> attach a check for this amount when you file. rr~A application fee. <br />5. Substance(s) to be mined (e.g., gold/silver/gravel): travel <br />5. 6wners(s) of Substance to be Mined <br /> (check applicable box(s)): x Private _ State _ Federal _ Indian <br />7. Owner(s) of Record of Affected Land <br /> (check applicable box(s)): ~ Private _ State _ Federal _ Indian <br />8. Type of Mining Operation <br /> (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 />COUNTI': Fremont <br />PRINCIPLE ER D A c ec one 6th (Colorado) <br />TOWNSIiIP (write number and check direction): T 10- <br />RANGE (write number and check direction): R ~ <br />SECTION (write number): S .~3~ <br />QUARTER SECTION (check one): _ NE <br />QUARTZ.R/QUARTER SECTION (check one): _ NE <br />GENEIL4L DESCRIPTION: <br />10th (New Mexico) Ute <br />North g South <br />_ East g West <br />NW SE _ SW <br />NW - SE SW <br />(mile:; and direction 13.25 miles south of Canon Gity <br />from nearest town and <br />appro;cimate elevation) 7740 ft. <br />* If the operator is a unit of State or county government, an application fee is not <br />required. A fraction of an acre must be counted as one acre for fee calculation. <br />