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REGULAR (112) PERMIT APPLICATION FORM -2- l General Location and Elevation I T15.R98W.Sec.27.NE y (parmit area liec within all foir (miles ana direction from i d quarter-quarter sections) Area is appoximately 25 air approx mate nearest town an site elevation) miles southwest of Meeker ~ CO. Elevation is about 6,550 12. county Rio Blanco 3a. Total Surface Acreage to be rn- cluded in Permit. (see Rule L1(2)) 37.1 acres Total Acreage of Affected Lands 3b. (see Rule 2.11(14)) 13.4 acres 14. Application Fee (see RUZE 2 to $620.00 determine amount, based on permitted area) I5. Present Land Use (i.e., agri- cultural, industrial, etc.) Rangeland, wildlife habitat, mineral activity 16. Surrounding Land Uses Rangeland, wildlife habitat, mineral activity 17. Proposed Future Lana vse (final Rangeland, wildlife habitat use after reclamation) .IB. List Mining Operations Currently None Zn Violation of the Act. (see 34-32-120) 19. The Lands Herein Do Not Affect The lands described ab ve d n t ffec f any of the Lands Described in described In S Ct• 5 Section 115(4)(f) of the Mined Land Reclamation Act. (specify affirmation) 1 1 MAPS AND EXHIBITS ft With each of the five (5) copies of the application form, the applicant must submit a correspond- ing set of the maps and exhibits outlined in RULE 2, as follows: 1. EXHIBIT A - Legal Description 2. EXHIBIT B - Index Map 3. EXHIBIT C - Pre-mining and Nlining P1 an Map(s) of Affected Lands 4. EXHIBIT D - Mining Plan 5. EXHIBIT E - Reclamation Plan 6. EXHIBIT F - Reclamation Plan Map 7. EXHIBIT G - Water Information 8. EXHIBIT R - Wildlife Information 9. EXHIBIT I - Soils Information 10. EXHIBIT J - Vegetation Information 11. EXHIBIT K - Climate 12. EXHIBIT L - Reclamation Costs EXHIBIT M - Compliance with Local Zoning ) EXHIBIT N - Other Permits or• Licenses ) ~ EXHIBIT O - Source of Legal Right to Enter ) 16. EXHIBIT P - Owners of Record of Surface and Subsurface Rights) See 34-32-115 (4)(e) 6 109 (6) & (8, See 34-32-115(4)&(4)(c) See 34-32-112(2)(d) See 34-32-112(2)(b)&(c)