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pf2r4r/A` <br />/-///~~•/'f • II I' lI I II I Il Illl 111 ~ ~ <br />i • .J/ <br />LIMITED IMPACT OPERATION (llo(z)) =E B 0 3 199 <br />APPLICATION FORM ~V~i^^-' i and <br />~.._ <br />The Application fora Limited Impact Operation Reclamption Permit contains three major <br />parts: (1) the Application Form, (2) the Application Exhibits A-F, and (3) the <br />application fee. When you submit your Application, be sure to include two si ned copies <br />of the Application Forth, two copies of Exhibits A-F, and a check for the app rca ron fee <br />described under (4) below. To expedite processing, please provide the information in <br />the format and order described in this form. //~y~~ Q~ ---7 <br />s asaaaaaaaaaaaaasaaaaaaaxaxaaaaaaaaxaaaaaaaaaaaaaxad=x~aei a3ae © O- (xxxxaeaexxxxxxxo=a <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, all information described below. <br />aaaataaasaaaaaaaooaasaaaaaaaaaoasaaaaaaasaaaaaaasaaaaeaxaxxaaaaaaaaaaxxxaxaaxaaeexexxaeex <br />1 . Applicant/Operator Name: MUPf~T I:JJ~J1'~1 i2osat~ 17f p~.2-rM ~"T <br />2. Operation Name (Pit, mine or site name): 1~T1-L~ p,r•n~o. ( <br />3. Application type: Limited Impact Operation (110). <br />4. Application Fee for Permitted Acreage* ~• 9 8 permitted acres. <br />(E10 x (affected acres) + 525.00).* <br />Note permitted acreage and application fee and ~,,_ <br />attach a check for this amount when you file. 8 75 application fee. <br />5. Substance(s) to be mined (e.g., gold/silver/gravel ): 2or~g Q~s~ D~/la~ffc2a~-. <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: <br />COUNTY: 'A,T <br />PRINCIPLE c ec one 6th (Colorado) 10th (New Mexico) Ute <br />TOWNSHIP (write number and check direction): T ~ _ /North South <br />RANGE (write number and check direction): R ~_ -_ East /West <br />SECTION (write number): 5 r <br />QUARTER SECTION (check one): _ _ NW SE _ SW <br />QUARTER/QUARTER SECTION (check one): NE NW /SE SW <br />GENERAL DESCRIPTION: <br />(miles and direction Z r.~~~~5 I.ilYS~ oP~L~S~i~J~S <br />from nearest town and <br />approximate elevation) Or..) C',p.~~~20~~~1~ <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 />