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T_,... • iii iiiiiiiiniuiii • ~~® ~~~ JAN 3 ~ 9ti( LIMITED IMPACT OPERATION (11DIMI~ED Np APPLICATION FORM _ L~1=GLAMA710 DItIISI ' This form contains two major parts: (1) General Operation Informat'on and (21 Exhibits A-G. When you submit your application, be sure to include two si n d copies of the General Operation Information, two copies of Exhibits A-G, and a c ck for the application fee described under (4) below. To expedite processing, please 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 escribed below. 1. Applicant/Operator Name: J ohn Dillon 2. Operation Name (Pit, mine or site name): lvillow Bend 3, Application type: Limited Impact Operation (1l O). 4. Application Fee for Permitted Acreage* 6 permitted acres. (Elo x (affected acres) + 525.00).* Note permitted acreage and application fee and Faid c attach a check for this amount when you file, heck #93 1 epplication fee. 5. Substance(s) to be mined (e.g „ gold/silver/gravel): Sand 6. Owners(s) of Substance to be Mined (check applicable box(s)): ~ Private ^ State ^ Federal ^ Indian 7. Owner(s) of Record of Affected Land (check applicable box(s)): ~ Private ^ State ^ Federal O Indian 8. Type of Mining Operation (check applicable box(s)): ~ Surface ^ Undergroun ^ In-situ 9. Location Information. The center of the area where the majority of mining will occur lies in: La Platat oC un~y, Township 35, 9w N1V quay er of the IVW q»arter of Section 3 COUNTY: La Flata PRINCIPLE MERIDIAN check one ^ 6th (Colorado) ~ 10th (New Mexico)^ Ute TOWNSHIP (write number and check direction): T 35 North ^ South RANGE (write number and check direction): R -T3- ^ East g]C West SEC TI ON.(write number): S -3- QUARTER SECTION (check one): ^~- ~ NW ^ SE ^ SW QUARTER/QUARTER SECTION (check one): ^ NE ® NW ^ SE ^ SW GENERAL DESCRIPTION: (miles and direction smiles north of Duran Colorado from nearest town and approximate elevation) EleQation 6,544 * If the operator is a unit of State or county government, an applica ion fee is not required. A fraction of an acre must be counted as one acre for fee c ltulation.