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f 4 • II I III I I I III I III I I I ~ pA_ . <br />• ~ ~ V ~ ~ V <br />~.1A~ i ~ l~@9 <br />LIMITED IMPACT OPERATION (110) NlINrD LAND <br />APPLICATION FORM C?ECLAMA71OhJ 171VISI0N <br />This form contains two major parts: (1) General Operation Information and (2) Exhibits <br />A-G. When you submit your application, be sure to include two si ned copies of the <br />General Operation Information, two copies of Exhibits A-G, and a~k for the <br />application fee described under (4) below. To expedite processing, please provide the <br />information 1n the format and order described in this form. ~_~~ _~~--_ <br />^~aae~v=ev-ee.oeo.o.c.oocvo.oevo.ev..ee.e.ooo,e.e.c..eea=eoo.e-v-oo---------o.eeeeovo.oev <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, all information described below. <br />1. Applicant/Operator Name: Lincoln CountT <br />2. Operation Name (Pit, mine or site name): Smith Raneh Pit #2 <br />3. Application type: Limited Impact Operation (110). <br />4. Application Fee for Permitted Acreage* permitted acres. <br /> (E10 x. (affected acres) + E25.00).* <br /> Note permitted acreage and application fee and <br /> attach a check for this amount when you file, application fee. <br />5. Substance(s) to be mined (e. g. , gold/si 1 ver/gravel) : Road Gravel <br />6. Owners(s) of Substance to be Mined <br /> (check applicable box(s)): ICl Private ^ State ^ Federal ^ Indian <br />7. Owner(s) of Record of Affected Land <br /> (check applicable box(s)): d Private ^ State ^ Federal ^ Indian <br />8. Type of Mining Operation <br /> (check applicable box(s)): OG 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: Lincoln <br />PRINCIPLE MERIDIAN check one m 6th (Colorado) D 10th (New Mexico)^ Ute <br />TOWNSHIP (write number and check direction): T 1~ ^ North Z] South <br />RANGE (write number and check direction): R Tj~- ^ East D West <br />SECTION (write number): S 10 <br />QUARTER SECTION (check one): ^~- ^ NW ^ SE ~l SW <br />QUARTER/QUARTER SECTION (check one): ^ NE ^ NW ^ SE A SW <br />GENERAL DESCRIPTION: ' <br />(miles and direction 7 miles south & 2 miles east from <br />from nearest town and <br />approximate elevation) Punkin Center, CO. Approx Elev. 5270'• <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 />