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i~C~IV~~~ <br />• RHGIILAR OPHRATION (112) <br />RsCLAPATION PHRMIT ~ JUN 0 8 1995 <br />APPLICATZON FORM <br />CHHCK ONH: Xx Nex Application (Rule 1.4.5) ~ AmtA[7Hrk!'6dabC0199YRule 1.10) <br />Conversion Application (Rule 1.11) <br />Permit No. M- (provide for amendments and conversions of existing <br />permits) <br />The application for a Regular Operation Reclamation Permit contains three major parts: (1) <br />the application form; (2) 8xhibits A-S and Geotechnical Stability 8xhibit; and, (3) the <br />application fee. When you auhhmit your application, be sure to include one (1) signed and <br />notarized original sad four (4) copies of the application form, five (5) copies of Hxhibits <br />A-R and say required sections of Exhibit S and the Geotechaical Stability Hxhibit, and a <br />check for the application fee described under Section (16) oa Page 3. Hxhibite should not <br />be bound or in a 3-ring binder; maps should be folded to 8 1/2" X li" or 8 1/2" S 14" size. <br />To expedite processing, please provide the information in the format and order described <br />in this form. <br />~- ~S ~(~ <br />eecae=asae=e=se=ae=aeeaaeevveeaavaeaeeecaeacvevaea=aeavuvseeeea=cove=ceae=csece.vc=ova= <br />GHNHRAL OPSRATIOIQ INFORMATION <br />Type or print clearly, in the space provided, all information described belox. <br />sacs==saes=evaeaavca=vvvvavvvvaaavvavaaaaaevvaaaevv=avevvvavvacsevvaaae=ceacamasaaace== <br />1. Applicant/operator or cempaay name (name to be used on permit): <br /> 1.1 Type of organization (corporation, partnership, etc.): County Government <br /> 1.2 I.R.S. Tax ID No. or Social Security Number: <br />2. Operation.aame (pit, mine or site same): Johnson Draw <br />3. Permi tted acreage (sew or existing site) 40 permitted acres <br /> 3.1 Change in acreage (+ or -) acres <br /> 3.2 Total acreage in Permit area 40 acres <br />4. Fees: <br /> 4.1 New Application 1~ 875.00 application fee <br /> 4.2 New Quarry Application 52 .325.00 quarry application <br /> 4.3 Milling Application (Non-DMO) S3. 100.00 milling application <br /> 4.4 Amendment Fee S1.550.00 amendment fee <br /> 4.5 Conversion to 112 operation (set by statute) 51.500.00 conversion fee <br />5. Primary commoditie(s) to be mined: Gravel <br />6. Name of owner of surface of affected land: States of f nlnrarin <br />7. Name of owner of subsurface rights of affected land: <br /> If 2 or more owners, refer to 8xhibit 0. ' <br />8. Type o£ mining operation: .x~ Surface IInderground In-situ <br />9. Location Information: the center of the area where the majority of. mining will <br /> occur lies in: ' <br /> COIINTY: Rio Blanco County <br />PRINCIPAL MHRSDZAN (check one): ~ 6th (Colorado) 10th (New Mexico) _ IIte <br />5HCTION (write number): S ~~ <br />TOWRSHIP (write number sad check direction) rth Sovth <br />RANGE (xrite number and check direction): R in? Sast )L West <br />QLII\RTHR SHCTION (check sae): _ NH ~ NW _ SE _ SW <br />QSARTHR/QIDIRTHR SHCTION (check one): NH NW SH SW <br />GHNHpn?• DHSCRIPTION (miles sad direction from nearest town and approximate <br />elevation): ]„, 75 milas Soffit hWast of RanoPly ['f] and Ern ihh of Rin Rlanrn <br />County Road No 2 <br />Flp ~1•i S7 S/ ~ <br />ORIGINAL <br />