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PERMFILE105913
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PERMFILE105913
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Entry Properties
Last modified
8/24/2016 9:58:45 PM
Creation date
11/24/2007 12:57:53 PM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
M1995004
IBM Index Class Name
Permit File
Doc Date
1/12/1995
Doc Name
REGULAR OPERATION 112 RECLAMATION PERMIT APPLICATION FORM
Media Type
D
Archive
No
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GRAND COUNTY, CO '9 013972 12/22/94 0337PM <br />PAGE 33 OF 43 ~A L ROSENE, RECORDER <br />Form 5510-I <br />'(May 19851 UNITED.STATES <br />DEPARTMENT OF THE INTERIOR <br />BUREAU OF LAND MANAGEMENT <br />FREE USE APPLICATION AND PERMIT <br />VEGETATIVE OR MINERAL MATERIAL <br />APPLICATION <br />.00 .00 <br />iEC-FEE DOC-FEE APL <br />FORM APPROVED <br />OMB NO. 1004-0001 <br />Expires: October 31. 1987 <br />Pcrmi[ Number <br />COC53397 <br />Expiration Date <br />January 1, 2000 <br />District <br />ame of applicant Address (include z+p code/ <br />Grand~Covnty Road & Bridge Dept. P.O. Box 9, Granby, CO 80446 <br />~Cind of material ROCk and SOil I Estimated quantity 75,000CU. VdS. <br />TOWNSHIP I RANGE I SECTION I SUBDIVISION _ <br />t 1 S. 81 W. 17 [dl/2 SWl/4 NW1/4 <br />I <br />°f Colorado I county of Grand <br />~vtaterials are [o be used for sand and gravel operat.i ons on public roads. <br />HEREBY AGREE TO COMPLY W ITH the special conditions az sc[ forth below. 1 CERTIFY That [he: (a) materials to be removed arc to be used (or the purpose noted <br />~bove; (b) none of the materials removed arc to be sold or bartered; (c) removal of matenals can begin only upon receiptof an approved copy of [his permit; and, (d) the <br />uthorizsd officer is to be noised upon compk[ion of removal.- <br />CERTIFY That 1 am a citizen o(the United States, and of the age o(majori[y in the Stott in which 1 reside. <br />1 FURTHER CERTIFY That the statemenLS made by me irtthis application arc true, complete, and correct [o [he best of my knowledge and belief and are made in good <br />with. <br />(Dater T~ (Signature of Applicant) <br />Title I g U.S.C. Section 1001, makes rt a crim<for any person knowingly and willfully [o make io any depanm<ni or agency of the United Slates any false, Ec[itioua, or fraudulent s[a[emenu or <br />~eprtxn[atiom as io any matter within itr lurisdicuoa <br />PERMIT <br />SPECIAL CONDITIONS <br />Is permit is hereby issued (or the materials applied for but may be canceled if it appears that this permit waz issued erroneously or the terms or conditions [on[ained <br />ercin are not observed. It_shall bc_subject to the following special conditions:_ _ _ _ _ _ _ _ _ _ _ _ _ _ . <br />GRAND COUNTY, CO 94014011 12/23/94 0404PM .00 .00 <br />' PAGE 34 OF 44 SARA L ROSENE,RECORDER REC-FEE DOC-FEE APL <br />See attached list of Special Conditions. <br />Information is collected to comply with Statutes (16 U.S.C. 606-606 and agent <br />'nforma[ion u treed to conCtrm the residence of the applicant. <br />Applicant mart respond to obtain a permit. <br />onservation practices must be carried out az provided by 43 CFR $51 I.1-I(b), <br />-3(c), and .3-3; <br />quipmen[, personal properly, and improvements must be removed within <br />ninety 190) days after expiration date 43 CFR 5511.3-5); <br />ny use of the surface of the lands involved in this permit shall be such az not to <br />terfere with any mining claim subject to [he provisions of Section 4 of the Act of <br />my 23, 1955 (l0 U.S.C. 613); <br />1 [ <br />'`~i~tg~ <br />~ ~ ' (Da[el <br />Officer) <br />r Regulations 143 CFR 551 LI-I([)). <br />Thc permi[tee shall clean up all work areas and shall remove or dispose oC all <br />refuse rcsutting from the pcrmittce's operations; <br />This permit is issued under [he Act of July 71, 1947, az amended, and 43 U.S.C. <br />and 1201, and under the free use privilege of the Act o(May 14, 1898 (Alazkal. <br />An annual report indicating the amount (cu. yds. or tons) of material removed <br />must be bled with the District Office on the anniversary date of the permit, or <br />within thirty (30J days a/Yer permit cxp+rauon. <br />APPUCaNr <br />
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