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: <br />* ~ III IIIIIIIIIIIIIIII <br />ii <br />LIMITED IMPACT OPERATION (110(2)) <br />RECLAMATION PERMIT <br />APPLICATION FORM <br />RE~~~~F <br />ocr o ~ ~ss~ <br />.~ ~ :e DIVISION ~- <br />MINERALS & UEv~ :;GY <br />The application for a Limited Impact Operation=,Reclamation Permit contains three major <br />parts: (1> the application form; (Z) Exhibits A-J; and, (3> the application fee. When <br />you submit your application; be sure to include two <Z) signed originals of the <br />application form, two <Z) copies of Exhibits A-J, and a check for 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. ))////~~~~ _/ <br />===c===a===evveo~ve===aevaa3==a3eeevveeavveeaevc¢dvde~~ ~~~a==a= .e .. ~~.5/~_==x=== <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, all information described below. <br />1. Applicant/operator name: f~iJER t"3~~r~wi La~1n ~r~apo2~4 rio~ <br /> <br /> 1.1 Type of organization (corporation, partnership, etc.): l"o RPoRAriunl <br /> <br />2. Operation name (pit, mine or site name): R~v~z3~n ~,+n GeA~ E~ 4~,'r <br /> <br /> Z.1 I.R.S. Tax ID No. or Social Security No.: S N - fl 8 9 6 S I <br /> <br />3. Permitted acreage q permitted acres <br /> <br /> 3.1 Application Fee $875.00 application fee <br /> <br />4. Substance(s) to be mined (e.g., gravel/gold/borrow): G2 a v G ~ <br /> <br />5. Name of owner of surface of affected land: 12tJE2~nT rorvl I~anJn ~nr2A <br /> <br />6. Name of owner of subsurface rights of affected-land: No ti!c <br /> <br />7. Type of mining operation: ~ Surface _ Underground _ In-situ <br />8. Location information. The center of the area where the majority of mining will <br /> occur lies in: <br /> COUNTY: ~E ~T rt <br /> PRINCIPAL MERIDIAN (check one): ~t 6th (Colorado) 10th (New Mexico) Ute <br /> TOWNSHIP (write number and check direction): T Lys North ~ South <br /> RANGE (write number and check direction): R g~w _ East ~ West <br /> SECTION (write number): <br />- S <br /> QUARTER SECTION (check one): NE NW SE _ SW <br /> QUARTER/QUARTER SECTION (check one): _ NE _ NW _ SE _ SW <br />GENERAL DESCRIPTION: <br />(miles and direction 1~; w. ~i a~ o~; ct <br />from nearest town and <br />approximate elevation) ly9~l N w~. 133 <br /> <br />