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• R~LAR (112) PERMIT APPLICATION ' FORM -2- 11. General Location and Elevation I eP~rnximately 15 miles south of Colorado (miles and ~9irection from t d i Springs, elevation 5330 nearest own an approx mate site elevation) I2. County E1 Paso i3a. Total Surface Acreage to be In- cluded in Permit. (see Rule 1.1(?)) Approximately 38.74 acres '3b. Total Acreage of Affected Lands (see Rule 2.11(14)) Approximately 38.74 acres 19. Application Fee (see RULE 2 to $500.00 determine amount, based on permitted az•ea) 15. Present Land Use (i.e., agri- cultural, industrial, etc.) Grass tan d 16. Surrounding Land Uses Same 17. Proposed Future Land Use (final Same use after reclamation) Z8. List Mining Operations Currently In Violation of the Act. (see 34-32-120) 14. The Lands He.~ein Do Not Affect $ 74 fects an of the any of the Lends Described in lands stated in Section 115(4) (f) of the i d Section I15(4)(f) of the M ne Land Reclamai`ion Act. (specify Mined Land Reclamation Act. affirmation) MAPS AND EXFlIBITS With each of the i`ive (5) copies of the application form, the applicant must submit a correspond- ing set of the maps and exhibits outlined in RULE 2, as follows: 1 2 3 9 5 6 7 8 9 10 11 12 13 19 15 16 EXHIBIT A - Iega1 Description - EXHIBIT B - Index Map EXHIBIT C - Pre-mining and Mining Plan Map(s) of Affected Lands EXHIBIT D - Mining Plan EXHIBIT E - Reclamation Plan EXHIBIT F - Reclamation Plan Map EXHIBIT G - Water Information EXHIBIT X - Wildlife Information EXHIBIT I - S~~ils Information EXHIBIT J - Vegetation Information EXHIBIT K - Climate EXHIBIT L - R~aclama ti On Costs EXHIBIT M - Compliance with Local Zoning ) EXHIBIT N - O;:her Permits or Licenses ) EXHIBIT O - Source of Legal Right to Enter ) EXHIBIT P - Owners of Record of Surface and Subsurface Rights) See 34-32-115(9)(e) 6109(6) 6(8) See 34-32-115(4)6(9)(cJ See 39-32-112(2) (d) See 39-32-112 (2) (b) 6 (c)