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<br />III IIIIIIIIIIIII III <br />999 <br />LIMITED IMPACT OPERATION (110(2)) <br />APPLICATION FORM Rec <br />on <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 si ned copies <br />of the Application Form, two copies of Exhibits A-F, and a check for the app rca ion fee <br />described under (4) below. To expedite processing, please provide the information in <br />the format and order described in this form, <br />______________________________________________~= 9-= ~0~====_________________________ <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, all information described below. <br />1. Applicant/Operator Name: xit Carson councy <br />2. Operation Name (Pit, mine or site name): tteintlzes Pic _ _ <br /> <br />3. Application type: Limited Impact Operation (110). <br />4. Application Fee for Permitted Acreage* 9.9 permitted acres. <br /> (;10 x (affected acres) + ;25.00).* <br /> Note permitted acreage and application fee and <br />N/A <br /> attach a check for this amount when you file. application fee. <br />5. Substance(s) to be mined (e.g., gold/silver/gravel): Sand & Gravel <br /> <br />6. Owners (s) of Substance to be Mined <br /> (check applicable box(s)): x Private _ State _ Federal _ Indian <br />7. Owner(s) of Record of Affected Land <br /> (check applicable box (s )): x Private _ State _ Federal _ Indian <br />8. Type of Mining Operation <br /> (check applicable box (s )): x Surface _ Undergroun d _ In-situ <br />9. Location Information. The center of the area where the majority of mining will <br /> occur lies in: <br />COUNTY: Che enne ~~ <br />~ <br />PRINCIPLE ER D c ecc one /6th (Col orado) 10th (New Mexico) Ute <br />TOWNSHIP (write number and che ck direction): T lz North x South <br />RANGE (write number and check direction): R 43 _ <br />East X West <br />SECTION (write number): S 1 _ <br />QUARTER SECTION (check one j: x ~- NW SE SW <br />QUARTER/QUARTER SECTION (check one): _ NE _ <br />_ NW g SE _ SW <br />GENERAL DESCRIPTION: <br />(miles and direction From Arapahoe 3/4 Mi East, 13 1/2 Mi Nor th <br />from nearest town and <br />approximate elevation) on County Rd 54. Elev. = 4136 <br />~RECEIV <br /> <br />JUN 1 9 1991 <br />Mined Land ~ _-" <br />lamation Divisi <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 />