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Form s51a1 • <br />' (July 1993) <br />UNITED STATES <br />DEPARTMENT OF THE 1NTER10R <br />BUREAU OF LAND MANAGEMENT <br />FREE USE APPLICATION AND PERYIT <br />VEGETATIVE OR MINERAL MATERIAL <br />i <br />Name of appbeant <br />MOFFAT C <br />APPLICATION <br />PORN APPROVED <br />OMB IVO. 111040991 <br />Pspires: May 31, 19% <br />Permrt Numhrr <br />COC 61232 <br />Fipualioa Date <br />11/lU/2U0 <br />Duuia <br />Craig <br />CO 81626 <br />F..:,w...A QYaawy .. .. _ _ _ <br />SUBDIVISION <br />T9N R96W 4 SE:SE', Portion) (35.29 Total <br />T9N R96W <br />9 N;NE; Portion) Acres) ,~ - <br />~ _ <br />~'1COi Colorado -~ <br />hlsrertaL as to be utod fw Coumy of Moffat ~ <br />Road Development and Maintenance ~~, <br />1 HEREBY AGREE TO CAYPLY WITtl the special waditioos as set fonh below. 1 CERTIFY Thu the: p) mamrius to be rcmoved art to be wed for the ~ - <br />abow; (b) nom of the muerials removed aro to be wb or hancred; (c) «moval o[materiau can he ~ od u a rcai t of as • roved eo of ibis rmpt utpor noted <br />aYIhO[Irad Ofitsr u to be notified upon completion of removLL im Y Po P DD PY i ~ Pe t; sod, (d) the <br />I CER'f3FY The 1 am • tauten of the Unrled State, sad of the aRe of majonty m the Stare m whrrL 1 recede. <br />.r- _ <br />1 FUR71iPJ1 CFJITIPY That the alatemeou made by me is this application are true, complae, and eorteta to the bet of my knowledge and belief and are made is goad <br />faith <br />DENNIS R. JONES, ROAD SUPERVISOR <br />/o"ac2~A <br />(Due) (Siptamre f Applicant) <br />TiW IS U.S.CSaaioa 1001, makri il•erimefor Yypcrwekoow,aaly Yd wdllydly to mate to Yydspsr,mem or yeary of thcUm IYO YytalY. rICIWpW.OI Ile11dY1LY1RWm[pY 0! <br />retasYrauoY Y b Y1 auWV „elia:u i..~.~....~ <br />PERMIT <br />SPEf1AL f 0NpR10NS <br />Ibis permit u hereby jutted for the matetiala a plied for but may be t aacelodd it appear that thin permit wu issued ertoneourly or the uttw or wtditiow wntained <br />herein as eta observed. It shsU be subject to the (ollowiu` apoda! woditiooc <br />1 <br />See Attachment A: Special Stipulations <br />COYervaYOa PYCporaarwr 6eortied out as provided bys3 CFR SS I I.1-1(b),.2-](c), <br />sad 17; <br />Fgwpmeat, penooal property, sad improvemeuu rnrrrt be removed wrthin ninny (90) <br />days after expiration due l3 CF3 5311.13); <br />Ray use of the surface of the hods iavawd u tbu permit ,hag be ,uch u om ro <br />iatra(ero srith Yy miaing.t.:.. tubjeq m the provtsioos of Secuon ~ of the Ace of Jay <br />?>. 1955 (30 USC. 613): <br />ll -io ~ y~ <br />Addres (areh,dr zip cads) <br />The permi.... shall .t... up all work arras sad shall remove or dispose of aV rdur <br />raWtioa from the pemurecl operations: <br />Thu permit is issued under the An of Jay 31, 1967, as amended, sad U U.S.C. and <br />tl01, ud under tlti (ns use privilege of the Ace LL hlay 11, 169t (AWka ody). <br />M amual report iadieaung the amount(w. ydt ormm) of material removed mwr be <br />filed with the Dump Office on the aamwnarydue of the permi4 of within rhury (30) <br />days {Irsr persnu expvuioa (AWka odY). <br />~~ i;xhibit N page ,#2 <br />nr t't.l t:tilr f <br />