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Form 5510-I
<br />(May 19e3> 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 />FORM APPROVED
<br />OMB NO. 1004-0001
<br />Expires: October 31, 1987
<br />Pumit Number '
<br />CO-050-RG-FU-90-13
<br />Expiration Dete
<br />Oct. 1, 1993; _
<br />District
<br />Name of applicant T'p~remdi{IEfu~etiiQnE~~Courthouse ~
<br />Fremont County I Canon City, CO 81212 ~
<br />Kind of material ~ I Estimated quantity I
<br />TOWNSHIP RANGE SECf10N SUBbI VISION
<br />49 N. 11 E. 2 NE}NE}
<br />I 1 II rlll.. .. .r I • •I I .: IN :~. I ..~
<br />State of ~ ' " ' ' ~ ~ ' ~ County of Fremont
<br />Colorado
<br />Materials are to be used for .., ~ ~ ~ ~ ~ ~, , ~ I ~ ~ ~ 1 '
<br />Cotinty Road Maintenance `'
<br />I HEREBY AGREE 70 COMPLY WITH the special~colnditions as set forth below, ICERTIFYITheI Ihc: (a) materials to be removcd are to be used for the purpose noted
<br />above; (b) none of the materials removed ere to be sold or bartered; (c) removal of materials can begin only upon receipt of an approved copy of this permit; and, (d) the
<br />authorized ofiar is to be notified upan:compkuoo of rcmovaL, : ,,.
<br />. _c! .,.411(11 :..Ur.ILnl<",71. i.~SS: L(3'.'' '' ~ .' .: '4 ~I" il. :.' .. ' '
<br />1 CERTIFY Thal I am a citizen of the United S4ete:~and of the age of majority in the Stare in which I reside.
<br />,rl cq;r.t pulctl.., .'p i::l i..uan I''':..,, .npi.r..... i..ln u., ,:, :. .II:, < I
<br />I FURTHER CERTIFY That the stalemrnts matle by me io this application are tore, ebinplele,'and cortect td the best of my knowledge and belie! and arc made is good
<br />faith. li% LL NetL:':4.~~r<u.{11~4.., 1: W:p, aIL ~'11q 111 U1L ., :Ji.,,l"- ~,. ,. Y, .. ~.,. ul..
<br />,:n .lc- ul Ipc rautgx
<br />pr; ItY:L(rl tit t{,:.r ( 1)/.L9tr•r/:..; o(Irv,l!:uy..; :r c_, ul,...:. nil ^~ ,, p~ La ,LO .~ ra4.l
<br />9 /nJ ~} L•npllr luuq< r.l rvu.urr,.'
<br />7 `l/~ /79C/'. ii I,uqu.,a rtuht.,l,l r:llr. l:y;asl ur .~: _..:I:r.u n,
<br />,.(Date),IS,:.-.n .~, <: ...n .,... ~,I. 1•.I.ay<rmq ..•o.w..
<br />of
<br />Titl< IB U.S.C. Seetioo 1001, make, it •eritoe foi my penon knowingly'arrd willfullyto make to any depanmrnr or agency of the United Suter any tetra, finitiow, or haudulem autemeou or
<br />rcpreaenutioruulo any nutter within itajurYdiuioa. ~i; I;, ,, ,,, „.1~I; ~: to<nlu r.~l
<br />.., I I.I, Ic oar. -.. PERMIT
<br />ld!b4CmVf r.fldbJl~.E~ t4"ul~.,... n!SPECIAL CONDITIONS •'~I. ,L:; :,n : (.,:,. ~.,, I
<br />I
<br />This permit is hereby issued fa/,the rpatprjals pliedios• bugmay~he tan4kd:Jit appean that this permit was issued erroneously or the terms or eonditiom contained
<br />hettin are not observed. It shell be subject to the following special conditions:
<br />1, Soil Conserva'ti'on''Sefvi~ce"Recl'amation' Plan`'tir"other approved plan will be utilized.
<br />2. Trees along th'e 'soutfiernl boundary of thepermit' area will be preserveti.~ ~~ ;
<br />3. Highwalls are not authorized. Final contours-will be maintained during the mine life.
<br />r.~rflUt
<br />Infortnatioo is collected to comply with Statute (16 U.S.C. 60406 end agency Regulations (43 CFR SS I I.I-I(Q). '
<br />Itt(ormatioa is used to eo~rm the residrntx of the applicant.
<br />Applicant must repoad to obtain s permit.
<br />Conservation practices tutus be carried out u provided by 43 CFR SS I I.1-I(b),
<br />.2-3(c), and .3-l;
<br />Equipment, personal property, and improvements must be removcd within
<br />ninety (90) days after expiration dare 43 CFR 5511.3-5);
<br />Any use of the surface of the lands involved in this permit shall be such az not to
<br />interfere with any mining claim subject to the provisions o(Section 4 of the Act of
<br />July 27, 1933 (3 U.S.C. 613);
<br />3
<br />The permittee shell clean up all work areas and shall remove or dupose of all
<br />refuse resulting from the permittee i operations;
<br />This permit is issued under the Act of July 31, 1947, u amended, and 4J U.S.C.
<br />and 1201, and under the free use privilege of the Act of May 14, 1898 (Alaska).
<br />An annual report indicating the amount (cu. yds. or tons) of material removed
<br />must be filed with the District Office on the anniversary date of the permit, or
<br />within thirty (30J days after permit expiration. :
<br />of Au[horiud
<br />A PPI (CANT
<br />
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