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l+ <br /> <br />Form 3310-I <br />(May 19g3) UNITED STATES <br />DEPARTMENT OF THE INTERIOR <br />BUREAU OF LAND MANAGEMENT <br />FREE USE APPLICATION AND PERMIT <br />VEGETATIVE OR MINERAL MATERIAL <br />APPLICATION <br />FORM APPROVED <br />OMB NO. 100441001 <br />Expire: October 31, 1987 <br />Pamir Number <br />CO-050-RG-FU-90-13 <br />Expiration Datc <br />Oct. 1 1993 <br />District <br />Name of applicant ress rn lu i r <br />~L~emdnf 4,rod'nE~~Courthouse <br />Fremont County___ Canon City, CO 81212 <br />Kind of material I Estimated quantity <br />Grnvnl <br />Give Iegel land dacriprion <br />TOWNSHIP RANGE SECTION SUBDIVISION _ <br />49 N. 11 E. 2 NE}NE} <br />State of County of <br />Colorado Fremont <br />Materials are to be uu:d for <br />Countv Road Maintenance <br />1 HEREBY AGREE TO COMPLY WITH the special conditions az sal fotth below. 1 CERTIFY That the: (a) materials to be rcmovcd arc to be uud for the purpose noted <br />above; (b) none o(the materials rcmovcd arc to be sold or battered; (c) rcmoval of materials can begin only upon receipt of an approved copy of this pcrmit; and, (d) the <br />authorized o~ttr is to be notified upon completion of rcmoval. <br />I CERTIFY That I am a citizen of the United Stares, and of the age of majority in the Stare in which I reside. <br />I FURTHER CERTIFY That the statements made by mein this application arc true, complete, and correct to the best of my knowledge and belief and arc made in good <br />fai[h. <br />~~~ ~ ~~~ <br />(Signature of Applicant) <br />Title 18 U.S.C. Section 1001, makes it a crime for any person knowingly and willfully to make to any department or agency of the United Slates any false, finitious, or frsudulenl sutemenU or <br />representations as to any matter within its jurisdinion. <br />PERMIT <br />SPECIAL CONDITIONS <br />This permit is hereby issued for the materials applied for but may be canceled if it appears that this pcrmit waz issucd erroneously or the terms or conditions contained <br />herein arc not observes. It shall be subjm to the following special conditions: <br />Soil Conservation Service Reclamation Plan or other approved plan will be utilized. <br />Trees along the southern boundary of the permit area will be preserved. <br />Highwalls are not authorized. Final contours will be maintained during the mine life. <br />Information is collected to comply with Statutes (16 U.S.C. 604.606 and agency Regulations (43 CFR 3311.1-1(~). <br />Information is used to confirm the residrna of the applicant. <br />Applicant must respond to obtain a pcrmit. <br />Conservation practices must be carried out as provided by 47 CFR 331 I.I-I(b), The permitter shall clean up all work areaz and shall remove or dispose of all <br />.2-7(c), and .3-3; refuse resulting from nc~ permittee's operations; <br />Equipment, personal property, and Improvements must be rcmovcd within This pcrmit is issucd under the Act of July 31, 1947, az emended, and 43 U.S.C. <br />ninety (90) days after expiration date 43 CFR 3311.3-3); and 1201, and under the free use privilege of the Act of May 14, 1898 (Alazka). <br />Any use of the surface of the lands involved in this pcrmit shall be such az not to An annual report Indicating the amount Icu. yds. or cons) of material rcmovcd <br />jnterferrwirh anyminirlgclaim subject to[he provisions of Sectjond of the Act of must be fled with the District Office on the anniversary dart of the permit, or <br />July 23, 1933 (30 U.S.C. 617); within rhirr l• (30) days ajirr pcrmit expiration. <br />(Date) -~ (Signature of Authorized Officer) <br />APPLICANT <br />