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<br />FWm 5510_7 UNITED STATES
<br />(October 1975) DEPARTMENT OF THE INTERIOR
<br />BUREAU OF LAND MANAGEMENT
<br />FREE USE APPLICATION At{q PERMIT
<br />VEGETATIVE OR MINERAL„HJ`i41T,ERIAL
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<br />Name of applicant
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<br />FORM APPROVED
<br />OMB NO. ~2-R087S
<br />Perm/1 Number ~~
<br />Explratlon Date .r
<br />- . ' ~ r o~~//7r f'
<br />Dlelricl '
<br />(include zip code)
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<br />f)uray County Bin C, Ouray, Colorado 81427 i
<br />Kind of materiel Estimated quantity
<br />Gravel 'I '•i~-
<br />Give legal land description
<br />TOWNSHIP RANGE SECTION SUBDIVISION
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<br />T. 45N R. 8 W. Sec. 3 ~':, NW)(, NW;6 I
<br />T. 45N R. 8 id. Sec. 3 4lyz, NE,(, N'+fK ~ '
<br />Area consists of 39.8Zacras,more or less, northeasterly 3.67 miles
<br />from the Town of Ridgway.
<br />Materials ere to be used for
<br />_ Roads and related work
<br />I HEREBY AGREE TO COMPLY WITH the special conditions es set forth below. f CERTIFY That the: (e) materiels ".'t ~'~
<br />to be removed ere to be used for the purpose noted ebwe; (b) none o[ the materiels removed ere to be sold or bartered;
<br />(c) removal of materiels can begin only upon receipt of an epprwed copy of this permit; and, (d) the authorized officer
<br />is to be notified upon completion of removal. ~
<br />I CERTIFY Thet I em twestyrone years of age or older, a cituen of the United States, end resident of the State of ~ j~
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<br />I FURTHER CERTIFY That the statements made by me in this application ere true, complete, end correct to the best
<br />of my knowledge end belief end are made-in good faith. i
<br />COUNTY OF OURAY "j
<br />September 3, 1976 BY:. ' ~ '
<br />I' (Date) ~ (Si afore of ApPl scent)
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<br />Title 18 U.S.C. Section 1001, makes it • crime for any person knowingly end willfully to make ~to any department or agency of the I
<br />United States any false, (iclitious, or fraudulent statements or representations as to any matter within its jurledlction.
<br />II ' _ ,, PERMIT ~ o .. ,
<br />~ I. .. .. SPECIAL CONDITIONS ... ... ~ .. !
<br />a~~ This permit is hereby issued [tlr the materiels applied foe but,mey be. canceled jf it appears that this permit was
<br />issued eeoneously a the.terma,ut fordition~ containgti herein ate not observed. It shell be .subject to the following
<br />~~~ epecielconditiona: ~ ~,r, .. ,. ,:. ,
<br />,' Se(: atirc^:I mininy plan.;and..spc~ia;::stinuiabigns.,~.;.,... ;..:,;,: ,
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<br />tit,: Li 1;!.:. ... _ .
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<br />Conservation practices must be practiced es provided .The permittee shell clean up all work areas end shell '
<br />~ by 43 CFR 5511.1-1(b), .2-3(c), and .3-3; remove or dispose of all refuse resulting from the
<br />Equipment, personal property, end improvements must permittee's operations; 1
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<br />be removed within ninety (90) days after expiration j
<br />date (43 CFR 3621.4(c) or 5511.3-5); ~ This permit is issued under the Act of July 31, 1947,
<br />as amended, and 43 U.S.C. 2 end 1201. !
<br />Any use 'of the surface of the lends involved in this i
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<br />permit shall be such es not to interfere with any mining ~~
<br />claim subject to the provisions of Section 4 of the Aet
<br />of July 23, 1955 (30 U.S.C. 613); -
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<br />(Date) (Slgnatur of Aulh rood Officer) `
<br />rcvosaz~ozs ~ ~-~;~. a ... APPLICANT ., ,.;~
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