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III IIIIIIIIIIIII III <br />_~,k <br />lay=H ~ i9g9 <br />LIMITED IMPACT OPERATION (110(2)) <br />APPLICATION FORM <br /> <br />The Applical:ion 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 Application Form, two copies of Exhibits A-F, and a check for the app rca ion fee <br />described under (4) below. To expedite processing, please provide the information in <br />the forniat and order described in this form. ~, q vc(y <br />GENERAL OPERATION INFORMATION <br />Type or• print clearly, in the space provided, all information described below. <br />1. Applicant/Operator Name: <br />2. Operation Name (Pit, mine or site name): TwiN CREEK GHMPGROUN~ <br />3. Application type: Limited Impact Operation (110). <br />4. Application Fee for Permitted Acreage* '7 q permitted acres. <br />(E10 x (affected acres) + E25.00).* <br />Note permitted acreage and application fee and <br />attach a check for this amount when you file. ~ c]S~ application fee. <br />5. Substar~ce (s) to be mined (e.g. , gold/silver/gravel ): S Hrv n + ~~ RAVES <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 /> <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 />COUNTY: 'rEl.l _1=12 f <br />PRINCIPLE AI~Tb ~ c ec one 6th (Colorado) <br />TOWNSHIP (write number and check direction): T 1~ <br />RANGE (write number and check direction): R ~_ <br />SECTION (write number): S <br />QUARTER SECTION (check one): _~ <br />QUARTER/QUARTER SECTION (check one): _ NE <br />GENERAL DESCRIPTION: <br />10th (New Mexico) Ute <br />North ~outh <br />_ East West <br />_ NW _ SE _ SW <br />NW SE SW <br />(miles and direction FLORTS.SAIU1- ~ MT(r <br />from nearest town and <br />approximate elevation) L.SDD <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 />