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99 <br />LIMITED IMPACT OPERATION (110) <br />RECLAMATION PERMIT <br />APPLICATION FORM <br />cz~c:El~lE~ ~~(1~1 <br />NOV 2'1 1994 ~ I ~I <br />s ~winFBSS ~~,eoso9Y~ ~~ <br />.1'ni~S)6i1 6 ~ ~,.. u, o <br />CHECK ONE: ~ New Appli'c/ation (Rule 1.4) Conversion Application (Rule 1.11) <br />Permit # M C~'i -~ (provide for conversions of existing pexmiCS) <br />The application for a Limited Impavct'71DYesignated Mining Operation Reclamation Permit contains <br />three major parts: (1) the application form; (2) Exhibits A-J, any required sections of <br />Exhibit S and Geotechnical Stability Exhibit, as required by Che Office, and outlined in <br />Rules 6.1, 6.2, 6.3, 6.4.19 and 6.5; and (3) the application fee. When you submit your <br />application, be sure to include one (1) sioned and notarized original and one (1) copy of the <br />application form, two (2) copies of Exhibits A-J, appropriate sections of 6.4.19 Exhibit S <br />and 6.5 (Geotechnical Stability fixhibit), as required, and a check for the application fee <br />described under (4) below. Exhibits should not be bound or in a 3-ring binder; maps should <br />be folded to 8 1/2" X il" or 8 1/2" X 14" size. To expedite processing, please provide the <br />information in the format and order described in this form. <br />-------- ---- ---- ---- ---- ----------- ------------------- <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, all information described below. <br />-------- -------------- ---- ----- ------------ ----- ----- <br />1. Applicant/operator name: .Dnv /~ 7• ~u S s r /~ <br />r <br />1.1 Type of organization (corporation, partnership, etc.): S ~,c1,'r,' c. 9! <br />1.2 I.R.S. Tax ZD No.: .5 ~ 3 - ~// ~- y9~ Soc• $« ~ <br />2. Operation name (pit, mine or site name) : ~ wss t/l G,-cr v e ~ % , f <br />3. Pezmitted acreage (new or existing site): ~ permitted acres <br />3.1 Change in acreage (+ or -) ~ ~ n//.R acres <br />4. Fees: <br />4.1 New Application 5875.00 application fee <br />4.2 Conversion Fee (from 110d to 110 875.00 conversion fee (Rule 1.11.2(2)) <br />5. Primary commoditie(s) to be mined: ~.-~ <br />6. Name of owner to the surface. of affected land: ~ n„ i r. J ~u S cr ~~ <br />7. Name of owner to the subsurface rights of affected land: ~~ y ~f 7. 4sic ~~ <br />e. Type of mining operation: ~ Surface _ 9nderground _ In-situ <br />9. Location information. The center of the area wee the majority of mining will <br />occur lies in: j „~~~~ <br />COIINTY: WI <br />PRINCIPAL MERIDIAN (check one): _ 6th (COlorado) 10th (New Mexico) _ Qte <br />SECTION (write number) : S .~ <br />TOWNSHIP (write number and check direction): T _~ North South <br />RANGE (write number and check direction): R ~ _ Hast (/West <br />QIIARTER SECTION (check one): _ NE ~ NW x SE _ SW ~~ <br />QOARTER/QIIARTfiR SECTION (check One): _ NE _ NW ~ SE _ SW <br />GENERAL DESCRIPTION: (miles and direction from nearest town and approximate <br />elevation) ~/ '/2 w, : 1 r s u., .- I-k n~ (~~(~s~~ ~-!) C a c t o _{' S -aZ 3- <br />10 <br />Correspondence information: <br />APPLICANT/OPERATOR (name, address <br />Individual's Name: v <br />Social Security No.: <br />Company Name: <br />Street: <br />and phone of name to be used on permit) <br />J. l~~.SSr/~ Title: l'JwNer- <br />c~~~r'y <br />