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II IIIIIIIII~~~~ ~II <br />sss <br />TWO-ACRE LIMITED IMPACT OPERATIOtJ (110(1)) <br />RECLAMATION PERMIT Diwsiono~ <br />APPLICATION FORM <br />v~ : . <br />~, <br />CHECK ONE: x New Application (Rule 3.3) Amendment Application (Rule 1.8) <br />Conversion Application (Rule 1.10) <br />The application for a Two-Acre Limited Impact Operation Reclamation Permit shall contain <br />three major parts: (1) the application form, (2) Exhibits A-I, and (3) the application <br />fee. When you submit your application, be sure to include one (1) original signed <br />application and one (1> copy of the application form, two (2) copies of Exhibits A-I, <br />and a check for the application fee described under (3> below. To expedite processing, <br />please provide the information in the format and order described in this form. mm <br />GENERAL OPERATION INFORMATION ~ a 3a~ <br />Type or print clearly, in the space provided, all information described b21ow. <br />1. Applicant/operator name: John 0. Buckner <br />1.1 Type of organization (corporation, partnership, etc.) Sole proprietor <br />2. Operation Name (pit, mine or site name): CRYSTALJACK (P1in.inE operations) <br />2.1 IRS Tax ID ho. or Social Security No.: <br />3. Permitted Acres: ~~ 0 ~ 2 60 pe fitted acres <br />3.1 Application fee: (New Application Only) .00 application fee <br />4. Substance(s) to be mined (e.g., gold/silver): Crystal nuneral specimens <br />5. Name, address, and phone number of the owner of th,e surface of the affected land: <br />U. S. Dept. of Agriculture, Forest Service, South Yark District Ranger (~19) 836-2031 <br />6. Name of owner of subsurface rights of affected lands: O.S. Bureau of Land rlanagement <br />7. Type of mining operation: X Surface _ Underground _ In-situ <br />8. Location Information. The center of the area where the majority of mining will <br />occur lies in: <br />COUNTY: Teller <br />PRINCIPAL MERIDIAN (check one) : x 6th (Colorado) 10th (New Mexico) <br />Ute <br />TOWNSHIP (write number and che _ <br />ck direction): T 11 _ North x _ <br />South <br />RANGE (write number and check direction): R 71 East X West <br />SECTION (write number): S _ <br />QUARTER SECTION (check one): NE NW SE x SW <br />QUARTER/QUARTER SECTION (check _ <br />one): <br />NE _ <br />_ <br />NW SE x SW <br />GENERAL DESCRIPTION: _ _ <br />_ <br />(miles and direction Approx. N-31°-E, 4.92 miles from Lake George, CO <br />from nearest town and <br />approximate elevation) 8,4oC ro 8,800 f eet above sea level <br />` Ri=~ElV~D <br />MAR 2 5 1993 <br />