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RECEIVE <br /> FEB 101990 <br /> LIMITED IMPACT OPERATION (110(2) ) MINED LAND <br /> APPLICATION FORM RECLAMATION DIVISION <br /> ' The Application for a Limited Impact Operation Reclamation 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 signed copies <br /> of the Application Form, two copies of Exhibits A-F, and a check for the app-TicTion fee <br /> ' described under (4) below. To expedite processing, please provide the information in <br /> the format and order described in this form. <br /> _ _�O === =1�3LL=== ras <br /> ' GENERAL OPERATION INFORMATIONS /(9/ <br /> Type or print clearly, in the space provided, all information described below. <br /> ' 1 . Applicant/Operator Name: High Plains Stone Co . <br /> 2. Operation Name (Pit, mine or site name): South 40 Quarry <br /> 3. Application type: Limited Impacit Operation (110). <br /> ' 4. Application Fee for Permitted Acreage* 9 . 8 permitted acres. <br /> ($10 x (affected acres) + $25.00)1.* <br /> Note permitted acreage and application fee and <br /> ' attach a check for this amount when you file. $125 . 00 application fee. <br /> 5. Substance(s ) to be mined (e.g. , gold/silver/gravel ): Surface Moss Rock <br /> 6. Owners(s ) of Substance to be Mined <br /> (check applicable box(s )): _ Private x State Federal _ Indian <br /> 7. Owner(s) of Record of Affected Land — — <br /> (check applicable box(s ) ): Private x State Federal Indian <br /> 8. Type of Mining Operation <br /> (check applicable box(s )): x 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: Fremont <br /> PRINCIPLE MERIDIAN (checkone): x 6th (Colorado) loth (New Mexico) Ute <br /> TOWNSHIP (write number and check direction): T 17 North South <br /> _ <br /> RANGE (write number and check direction): R 68 _ East x West <br /> SECTION (write number): S 14 IS <br /> QUARTER SECTION (check one): NE KW —_ SE — SW <br /> QUARTER/QUARTER SECTION (check one): NE NW SE SW <br /> GENERAL DESCRIPTION: <br /> ' (miles and direction 15 miles PIE of Penrose on Colo Hwy 115 <br /> from nearest town and <br /> approximate elevation) 6800 feet above sea level <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 />