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<br />LIMITSO IMPACT o~PSRAB~T (110) RFrFIVF~ <br />R8[~r.nwnTr <br />APPLICATION FORM qPR 18 1996 <br />CHHCR ON&: _~ New Application (Rule 1.4) ~ Conversion Application (Rule 1.11) <br />Permit # M - <br />(provide for conversions oQ~v~~~l~?r~aS-t01p9Y <br />The application for a Limited Impact Designated Mining Operation Reclamation Permit coatai.as <br />three major parts: (1) the application form; {2) 8xhibits A-J, any required sections of <br />8xhibit S and Geotechnical Stability 8xhibit, as required by the Office, and outlined in <br />Rules 6.1, 6.2, 6.3, 6.4.19 and 6.5; and (3) the applic ion fee. When you submit your <br />application, be sure to include one (1) si ed and notarize original and one (1) copy of the <br />application form, tro (2) copies of 8xhibite A-J, appropri to sections of 6.4.19 fixhibit S <br />and 6.5 (Geotechnical Stability 8xhibit), as required, and a check for the application fee <br />described under (4) below. 8xhibits should not be brnmd or in a 3-ring binder; maps should <br />be folded to 8 1/2" X 11" or 8 1/2• X 14• size. TO expedite processin please provide the <br />information in the format and order described is this form. ~~ ~_(j~ _~~ ~1 <br />GfiNHRAL OPBRATION INFORMATION <br />Type or print clearly, in the space provided, all iEfor~Ei® described belor. <br />1. Applicant/operator or company name (name to be <br />Sutherland Bros., Inc. <br />1.1 Type of organization (corpo <br />1.2 I.R.S. Tax ID No. or Social <br />2. Operation name lpit, mine or site <br />3. Permitted acreage (aev or 'stir! <br />3.1 Change is acreage l+ -) <br />4. Fees: ~ / <br />4.1 New Application - ~ <br />4.2 Coave Fee (from 110dIb <br />5. Primary commodie(s) to~be mind <br />6. Fame of over to <br />7. Name of ogner to <br />m, a p, etc.): <br />u-ity : 870- <br />;): eimer #2 <br />i i <br />.~e, . 9.9 <br />permitted acres <br />acres <br />~ 5875.00 application fee <br />110 875.00 conversion fee (Rule 1.11.2(2)) <br />/, <br />affected load: <br />of affected land: <br />lJeimer Ranches <br />Weimer Ranches <br />8. Type of g ratios: X Surface _ Dsdergrouad _ In-situ <br />9. Location info tion. a center of the area There the majority of mining rill <br />occur lies in: Montrose ~ ~ <br />PRINCIPAL MHRID (check one): i _ 6th (Colorado) x 10th (Nev McXico) _ Ote <br />SECTION (write r): S ~~ <br />SOWNSBIP (write number sad check,di.rection): T 46 }~( North _ South <br />RANCH (Trite number sad check direction): R ~~ _ Bast -. )(~ West <br />QOAFSHR SSCTIOF (check one) : ~ _ NH _ NW X~+' SH ~ Si1 <br />Q/Qd21RTHR SBCTION (clier3c one) : _ NH _ NW ~ SB ~ SW <br />GBNBZtAL DBSCRIPTION: (miles and direction from nearest toxn and approximate <br />elevation) Pit will be located approximately one mile south of Nucla. CO, with <br />the elevation approximately 5900 feet <br /> 10. Correspondence Information: <br /> APPLICANT/OPHRAIOR (n ame, address, and phone of name to be used on permit) <br /> Contact's Name: T,PP Sutherland Title:PreGident <br /> CAS. Rein: Sutherland Bros.. Inc. <br /> <br />cr, o <br />Y <br />. <br />~ Street: P.O. Box 126 <br />'p of , <br />r <br />O W City: Nucla <br />N r <br />cC a~ <br />m State: o ors o 81424 <br />Zip Code: <br />v a-i ~ ~ Area Code: 970 Telephone: 864-7662 <br /> <br />Q G i~ <br /> ~ a~ <br />~ ' <br /> ,o <br />.~ <br /> 0 <br />