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cr 27 1993 LIMITED IMPACT OPERATION (110(211 RECLAMATION PERMIT ~ =:n~ APPLICATION FORM The application for a Limited Impact Operation Reclamation Permit contains three major parts: (1) the application form; (2) Exhibits A-J; and, (3) the application fee. When you submit your application, be sure to include two (2) signed originals of the application form, two (2) copies of Exhibits A-J, and a cTieccT-for the application fee described under (3) below, To expedite processing, please Drovide the information in the format and order described in this form, qq -==-----=-==------------------------------ -- GENERAL OPERATION INFORMATION Type or print clearly, in the space provided, all information described below. 1. ApDliCant/operator name: Logan County Board of Commissioners 1.1 Type of organization (corporation, partnership, etc.): County Government 2. Operation name (pit, mine or site Hamel: Lindstrom Gravel Pit 2.1 I.R.S. Tax ID No. or Social Security No.: 3. Application fee for permitted ac reage* 9.98 permitted acres Note permitted acreage and application fee and attach a check for this amount when you file. gg75 application fee 4. Substance(s) to be mined (e. g., gravel/gold/borrow): Sand ~ Gravel 5. Name of owner of surface of affected land: 6. Name of owner of subsurface rights of affected land Neil M. Lindstrom Same 7. Type of mining operation: g Surface Underground In-situ 8. Location information. The center of the area where the majority of mining will occur lies in: COUNTY: Logan PRINCIPAL MERIDIAN (check one): X 6th (Colorado) 10th (New Mexico) Ute TOWNSHIP (write number and check direction): T 6 X North South RANGE (write number and check direction): R 51 - East ~ West _ SECTION (write number): S 17 _ _ QUARTER SECTION (check one): -AE x NW SE SW QUARTER/QUARTER SECTION (check one): x NE NW - _ SE SW GENERAL DESCRIPTION: (miles and direction eleven miles southeast of Sterling from nearest town and approximate elevation) annrnx;mately 4600 ft * A fraction of an acre must be counted as one acre for fee calculation. If the operator is a unit of state or County government, an application fee is not required.