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r l! l~ ..,-9 x4,a ~! <br />JAN ? J 199 <br />LIMITED IMPACT OPERATION (110) (y))~~~.,; ;_,~~ ~ <br />APPLICATION FORM 17EClANiATIOiU ,a~ .':"!'~r~! <br />This form contains two major parts: (1) General Operation Information and (2) Exhibits <br />A-G. When you submit your application, be sure to include two si~n~ed~ copies of the <br />General Operation Information, two copies of Exhibits A-G, and a- c~ieck for the <br />application fee described under (4) below. To expedite processing, please provide the <br />information in the format and order described in this form. ,2~__~%~j_ : ~•~- ; ; S <br />GENERAL OPERATION INFORMATION ~~ ~ ~' ~~ <br />Type or print clearly, in the space provided, all information described below. <br />1. Applicantl0perator Name: J-,i~1d.e Ir_c. <br />2. Operation Name (Pit, mine or site name): ,7_RuA P site <br />3. Appli~:ation type: Limited Impact Operation (110). <br />4,. Application Fee for Permitted Acreage* L' permitted acres. <br /> (E10 a (affected acres) + E25.00).* <br /> Note permitted acreage and application fee and <br /> attach a check for this amount when you file. .m10 ;.00 application fee. <br />5, Substance(s) to be mined (e.g., gold/silver/gravel): r~l n.~ CA YI C~ ri ~'.'L$~( <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 /> (check applicable box(s)): © Private ^ State ^ Federal ^ Indian <br />8. Type of Mining Operation <br /> (check applicable box(s)1: ® Surface ^ Underground ^ In-situ <br />9. Location Information. The center of the area where the majority of mining will <br /> occur lies in: <br />C(iUNTY: rrovrers /( <br />~ <br />~ <br />PF:INCIPLE MERIDIAN check one I~}' 6th (Colorado ^ 10th (New Alexi co)^ Ute <br />TOWNSHIP (write number and check rectio n): T 3 ^ JJorth ® South <br />RANGE (write number and check direction): R ~ ^ East p West <br />SECTION (write number): S 1'~' <br />QUARTER SECTION (check one): ^ NE p NW ^ SE ^ SW <br />QUARTER/QUARTER SECTION (check one): ® NE ^ NW ^ SE ^ SW <br /> <br />GENERAL DESCRIPTION: ~ <br /> <br />~ <br />(miles and direction t- a wwf <br />from nearest town and / ~ ,~' <br />approximate elevation) / , <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 />