PERMFILE123474

• Permit No: M1994103
• IBM Index Class Name: Permit File
• Doc Date: 6/21/1995
• Doc Name: LIMITED IMPACT OPERATION 110 RECLAMATION PERMIT APPLICATION FORM
• Media Type: D
• Archive: No

II IIIIIIIIIIIII III • `~~'~'~ ~~
999 ~ ,.
-4- RECEIVED ~~
LIMITED IMPACT OPERATION (110) JUN 2 ~ 1995
RECLAMATION PfiRMIT
APPLICATION FORM ~~ft AAee,,
CHECK ONE: New Application (Rule 1.4) Conve rsion~~~~ri Ca'~i~~~S B(fiflrnlg91t .11)
Permit # M~- ~Q ~. (provide for conversions of existing permits)
The application for a Limited Impact Designated Mining Operation Reclamation Permit contains
three major parts: (1) the application form; (2) Exhibits A-J, any required sections of
Exhibit S and Geotechnical Stability Exhibit, as required by the Office, and outlined in
Rules 6.1, 6.2, 6.3, 6.4.19 and 6.5; and (3) the application fee. When you submit your
application, be sure to include one (1) ~ivned and notarized original and one (1) copy of the
application form, two (2) copies of Exhibits A-J, appropriate sections of 6.4.19 Exhibit S
and 6.5 (Geotechnical Stability Exhibit), as required, and a check for the application fee
described under (4) below. Exhibits should not be bound or in a 3-ring binder; maps should
be folded to 8 1/2" X 11" or 8 1/2" X 14" size. To expedite processing, ple a provide the
information in the format and order described in this form.
---- ---- --------- ------ ---- ----
GENERAL OPERATION INFORMATION
Type or print clearly, in the space provided, all information described below.

1. Applicant/operator name: W LL C_EJ~/
1.1 Type of organization (corporation, partn rship, etc.):
1.2 I.R.S. Tax ID No.fQf SS(V ~~ ~~~ ~,
''
//
Operation name (pit, mine or site name) : ~I el~~_ Vi'~ .~ .D~
3. Permitted acreage (new or existing site): ~ permitted acres
3.1 Change in acreage (+ or -) acres
a. Fees:
4.1 New Application 5875.00 application fee
4.2 Conversion Fee (from 110d to 110
7
.00 conversion fee (Rule
8
5 1.11.2(2))
5 . /'
~
~
~
Primary commoditie (s) to be mined: ~V 11~

E .
Name of owner to the surface of affected land: ~ ST
_r.GL. ~ /~~ ,, ~}-~
/
ll/~/~v
r
~. /
Name of owner to the subsurface rights of affected land: ~ ST /
~
rLL~ ( CP/~
e. Type of mining operation: ~ Surface _ Onderground _ In-situ
9. Location information. The center of the area where the majority of mining will
occur lies in:
COON'1'Y
PRINCIPAL MERIDIAN (check one): (Colorado) 10th (New Mexico) _ Ote
SECTION twrite number): S ~Q
TOWNSHIP (write number and check direction): T North }~S6uth
RANGE (write number and check direction): R _ East ,/West
QQARTER SECTION (check one): _ NE _ NW _ SE _ SW
QQARTfiR/QIIARTfiR SECTION (check one): _ NE _ NW _ SE _ SW
GENERAL DESCRIPT~3¢¢N: (au_les and direction frocg nearest~pwn an pproximat
elevation) ~3~z ~.,. 7~¢.. ~t c.~-a~zf- ~J =Fte-TL^1^~ (~~4` ~~ /
10. Correspondence Information:
APPLICANT/OPERATOR (name,
Individual's Name: _
Company Name: _
Street:
of name to be used on per/m~i t)~~ ~~ ~
r~J/li/~ TitleL ~l~R)P7Jic..b.~i~xt~