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III IIIIIIIIIIIIIIII ~ <br />-1- <br /> <br />DEC ~ ~ - <br />LIMITED IMPACT OPERATION (110(2)) <br />APPLICATION FORM <br /> <br />The Application fora Limited Impact Operation Reclamation Permit contains three major <br />parts: (1) the Application Form, (2) the Application Exhibits A-F, and (3) the <br />application fee. When you submit your Application, be sure to include two signed copies <br />of the Application Form, two copies of Exhibits A-F, and a check for the appT ci~a ion fee <br />described under (4) below. To expedite processing, please provide the information in <br />the format and order described in this form. <br />__________________________________________________~'=?=9~?= Y~====______________________ <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, all information described below. <br />1. Applicant/Operator Name: xrnwa cnnN~rv, cnr.nReon <br />2. Operat~lon Name (Pit, mine or site name): GRAY PIT <br />3. Application type: Limited Impact Operation (110). <br />4. Application Fee for Permitted Acreage* 9.7 permitted acres. <br />(S10 x (affected acres) + 525.00).* <br />Note p~armitted 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/silver/gravel): cepvEl. <br />6. Owners (s) of Substance to be Mined <br />(check applicable box(s)): X Private i State _ Federal _ Indian <br />7. Owner(s) of Record of Affected Land <br />(check applicable box(s)): ~ Private _ State i Federal i Indian <br />8. Type o•F Mining Operation <br />(check applicable box(s)): ~ Surface _ Underground i In-situ <br />9. Location Information. The center of the area where the majority of mining will <br />occur lies in: <br />COUNTY: KIOWA <br />PEIINCIPLE ec one X 6th (Ca <br />TOWN9iIP (write number and check direction): <br />R1WGE (write number and check direction): <br />SECTION (write number): <br />QUARTER SECTION (check one): w 1/2 <br />Ql1ARTER/QUARTER SECTION (check one): <br />GENERAL DESCRIPTION: <br />lorado) 10th (New Mexico) Ute <br />T _~ North ~ South <br />$ ~_ _ East ~ West <br />~~ NW ~ SE SW <br />NE - NW g SE ~ SW <br />(miles and direction From Haswell: lU M. West. 3 Miles North <br />from nearest town and From Arlington: 1 Mile West, 11 Miles North <br />approximate elevation) 4538 <br />* If the operator is a unit of State or county government, an application fee is not <br />required. {1 fraction of an acre must be counted as one acre for fee calculation. <br />