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~~c~av~ <br />oar 1 ~sss <br />Moto~Depl of ae urat Resour0'~ <br />• <br />LIMITED IMPAC7 OPERATION (110) <br />APPLICATION FORM <br />., ~.~. .: <br /> <br />This farm contains two major parts: (1) General Operation Information and (2) Exhibits <br />A-G. When you submit your application, be sure to include two --sig~n--e~d copies of the <br />General Operation Information, two copies of Exhibits A-G, and ask for the <br />application fee described under (4) below. To expedite processing, please provide the <br />information in the format and order described in this form_ ~_~~_ ~yo_____~__Ia__5___l~_C_______s_(_~_~1_s_ <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, all information described below. <br />1 . Applicant/Operator Name: Uni vevsa I PecY- , So „~( 4 ..~I ~7r~ va l i 1 n c. <br />2. Operation Name (Pit, mine or site name): /~]arr~~l ln/r:oht- P;f <br />3. Application type: Limited Impact Operation (110). <br />4. Application Fee for Permitted Acreage* `J, 9' permitted acres. <br />(E10 x (affected acres) + E25.00).* <br />Note permitted acreage and application fee and <br />attach a check for this amount when you file. ~(a..S,o o application fee. <br />5. Substance(s) to be mined (e. g., gold/silver/gravel): S4„d 4,,,d g,-~,vQ/ <br />6. Owners(s) of Substance to be Mined <br />(check applicable box(s)): ~ Private ^ State ^ Federal ^ Indian <br />7. Owner(s) of Record of Affected Land <br />(check applicable box(s)): ® Private ^ State ^ Federal ^ Indian <br />8. Type of Mining Operation <br />(check applicable box(s)): ~ Surface ^ Underground ^ In-situ <br />9. Location Information, The center of the area where the majority of mining will <br />occur lies in: Sn„ne ~s ;h M-~5~o~ <br />COUNTY: <br />PRINCIPLE MERIDIAN chec one ^ 5th (Colorado) ^ 10th (New Mexico)^ Ute <br />TOWNSHIP (write number and check direction): T ^ IJorth ^ South <br />RANGE (write number and check direction): R ^ East ^ West <br />SECTION (write number): S <br />QUARTER SECTION (check ane): per- ^ NW ^ SE ^ SW <br />QUARTER/QUARTER SECTION (check one): ^ NE ^ NlJ ^ SE ^ SW <br />GENERAL DESCRIPTION: <br />(miles and direction <br />from nearest town and <br />approximate elevation) <br />* If the operator.is a unit of State or county government, an application fee is not <br />required. A fraction of an acre must be counted as one acre for fee calculation. <br />