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~; - iii iiiiiiiiiiiii iii .. ~ RECEIVED APR 241987 LIMITED IMPACT OPERATION (110) APPLICATION FORM MINED LAND RECLAMATION DIVISION This form r:ontains two major parts: (1) General Operation Information and (2) Exhibits A-G. When you submit your application, be sure to include two sigg~ned copies of th~ General Operation Information, two copies of Exhibits A-G, and aleck for the f application fee described under (4) below. To expedite processing, please provide the information i n the format and order descri bed i n this form. fi _~ y _~ ~a_ x,35. ~_ CK S.3cS GENERAL OPERATION INFORMATION Type or print clearly, in the space provided, all information described below. 1. Applicant/Operator Name: Stanle~ J. Conner 2. Operation Name (Pit, mine or site name): I.ee N~. 2 P'::c.Pr 3. Application type: Limited Impact Operation (110). 4. Application fee for Permitted Acreage* (E10 x (affected acres) + E25.00).* Note permitted acreage and application fee and attach a check for this amount when you file. 5. Substance(s) to be mined (e. g., gold/silver/gravel) 6. Owners(s) of Substance to be Mined (check applicable box(s)): ^ Private 7. Owner(s) of Record of Affected Land / e~'S i~~eN l ~1 Ci -1.0...pL.. permitted acres. 25_0. application fee. . Gold ^ State f] Federal ^ Indian (check applicable box(s)): ^ Private ^ State © Federal ^ Indian 8. Type of Mining Operation (check applicable box(s)}: d Surface ^ Underground ^ In-situ 9. Location Information. The center of the area where the majority of mining will occur lies in: CJUNTY: G;.1 in P2INCIPLE MERIDIAN check one 6th (Co lorado) ^ 10th (New Mexi co)^ Ute TOWNSHIP (write number and check i ection): T ~ ^ tlorth ~l South R~aNGE (write number and check direction): R 1 ^ East ~;] West SECTION (write number): ~ S 20 QUARTER SECTION (check one): ^-A~ ® NW ^ SE ^ SW g11ARTER/QUARTER SECTION (check one): ^ NE ^ NW %~ SE ^ SW G1=NERAL DESCRIPTION: (miles and direction ~ ~; ;p~ SE of central ci ty from nearest town and approximate elevation) * If the oGierator is a unit of State or county government, an application fee is not required. !1 fraction of an acre must be counted as one acre for fee calculation.