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~~~ % <br />v <br />~ ~~~~~~~~~~~~~~~~~~~ ~~~~`M~~~ <br />aPR 13 i39U <br />LIMITED IMPACT OPERATION (110(2)) MINED LAND <br />APPLICATION FORM ;rn unrin~~ n~~• <br />The Application fora Limited Impact Operation Reclamation Permit contains three major <br />parts: (1) the Application Form, (2) the Application Exhibits A-F, and (3) the <br />application 1'ee. When you submit your Application, be sure to include two s~~i nam~ed copies <br />of the Appli<:atian Form, two copies of Exhibits A-F, and a check for the appTical;i•on fee <br />described under (4) below. To expedite processing, please provide the information in <br />the format and order described in this form. /M~ R~~} ~f <br />eevsaeeao-=onee~eeeo=eee.eoe.vxeeeeeeeeee:eeesde~ee'33sede ~~eeaaee=eeeaee=aae_=se~vessa:a <br />GENERAL OPERATION INFORMATION <br />.Type or print clearly, in the space provided, all information described below. <br />1. Applicant/Operator Name: Fremont County Board of County Commissioners <br />2, Operation Name (Pit, mine or site name): ni~a emir ( rk Pi <br />3, Application type: Limited Impact Operation (110). <br />4, Application Fee for Permitted Acreage* 2.?3 permitted acres. <br />(;10 x (affected acres) + ;25,00),* <br />Note permitted acreage and application fee and <br />attach a check for this amount when you file. N/A application fee. <br />5, Substance(s) to be mined (e .g „ gold/silver/gravel): rra~Pr <br />6. Owners(.s) of Substance to be Mined <br />(check applicable box(s)): _ Private _ State XxX Federal _ Indian <br />7, Owner(s) of Record of Affected Land <br />(check applicable box(s)): _ Private _ State YxX Federa) _ Indian <br />8. Type of Mining Operation <br />(check applicable box (s )): xxx Surface _ Underground _ In-situ <br />9. Location Information. The center of the area where the majority of mining will <br />occur lies in: <br />COUNTY: <br />PRINCIPLE E A! c ecc one ~ 6th <br />(Colorado) <br />10th <br />(New Mezico) Ute <br />TOWNSNIP (write number and check directio n): T 49 xx North South <br />RANGE (write number and check direction): R 11 gat East - West <br />SECTION (write number): S z <br />QUARTER SECTION (check one): ~~~ NW SE SW <br />QUARTER/QUARTER SECTION (check one): ~ NE _ <br />_ NW _ SE _ SN <br />GENERAL DESCRIPTION: <br />(miles and direction ~innrnvimataly 17 milac Nnrth of Cntnnaxi nn <br />from nearest town and <br />approximate elevation) rho Wo cr aiAo of F r Rnnd /'17. Flovnrinn Q ?00 ft. <br />* If the operator is a unit of State or county government, an application fee is not <br />required. A. fraction of an acre must be counted as one acre for fee calculation. <br />