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<br />~~G~~~~~ <br />JUL_; 1991 <br />LIMITED IMPACT OPERATION (110(2)) <br />RECLAMATION PERMIT <br />APPLICATION FORM <br />Mined sand <br />Reclamation Division <br />The application for a Limited Impact Operation Reclamation Permit contains three major <br />parts: (1) the application form; (2) Exhibits A-J; and, (3) the application fee. When <br />you submit your application, be sure to include two (2) ssi~~n~e~d originals of the <br />application form, two (2) copies of Exhibits A-J, and a c- ecrfor the application fee <br />described under (3) below. To expedite processing, please provide the information in <br />the format and order described in this form. 9 1- O <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, all information described below. <br />i ~ 9 i~iii9i9~ii~i2l1i392i2i33li~ii~lii33iSiSi~9i9.9i ii 9 <br />1. Applicant/operator name: Mike Coleman and is rrv SaiPert. <br />1.1 Type of organization (corporation, partnership, etc.): Partnership <br />2. Operation name (pit, mine or site name): Ola Pit <br />2.1 I.R.S. Tax ID No. or Social Searity No.: <br /> <br />3. Application fee for permitted acreage* 9.98 permitted acres <br />(525..00 + 10/acre)* <br />Note permitted acreage and application fee and <br />attach a check for this amount when you file, g875_nn application fee <br />4. Substance(s) to be mined (e.g., gravel/gold/borrow): Gravel <br />5. Name of owner of .surface of affected land: <br />6 <br />7 <br />8 <br />Mike Coleman S Jerry Seifert <br />Name of owner of subsurface rights of affected land: state Boara of Lana comm. <br />Type of mining operation: X Surface _ Underground _ In-situ <br />Location information. The center of the area where the majority of mining will <br />occur lies in: <br />COUNTY: CnRf.PY <br />PRINCIPAL MERIDIAN (check one): Y 6th (Colorado) 10th (New Mexico) Ute <br />- <br />TOWNSHIP (write number and check direction): T 22 North south <br />x <br />RANGE (write number and check direction): R <br />_ <br />7 3 East ~ West <br />SECTION (write number): _ <br />. <br />S ~i <br />QUARTER SECTION (check one): NE NW SE ~ SW <br />QUARTER/QUARTER SECTION (check one): = NE _ NW = SE x_ SW <br />GENERAL DESCRIPTION: <br />(miles and direction Three miles west of Westcl iffe, CO at an <br />from nearest town and <br />approximate elevation) elevation of approximately 8300 feet <br />* A fraction of an acre must be counted as one acre for fee calculation. If the <br />operator is a unit of state or county government, an application fee is not required. <br />1 <br />