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<br />iiiiiuiiiiniiiiii <br />~~~~~~~® <br />fnAY 2 01987 <br />LIMITED IMPACT OPERATION (110) ('AINED Lf~ND <br />APPLICATION FORM ~stCLkMATlON DIVISION <br />This form contains two major parts: (1) General Operation Information and (2) Exhibits <br />A-G. When you submit your application, be sure to include two ~siggn~ed copies of the <br />General Operation Information, two copies of Exhibits A-G, and as cock for the <br />application fee described under (4) below. To expedite processing, please provide the <br />information in the format and order described in this form.~,~ 7.9~ ~h o -,,t~o7~ <br />- ----------- <br />GENERAL OPERATION INFORMATION <br />Type or• print clearly, in the space provided, all information described below. <br />1. Applicant/Operator Name: Jordar. C. or Jone L. Burdick <br />2. Operation Name (Pit, mine or site name): B & G Stone . <br />3. Application type: Limited Impact Operation {110). <br />4, Application Fee for Permitted Acreage* <br />(E10 x (affected acres) + E25.00).* <br />Note permitted acreage and application fee and <br />attach a check for this amount when you file. <br />5 permitted acres. <br />;75.00 application fee. <br />5, Substance(s) to be mined (e. g., gold/silver/gravel): F1: g Stone <br />6. Owners(:s) of Substance to be Mined <br />(check applicable box(s)): X8 Private >s.l State ^ Federal ^ Indian <br />7, Owner(sl of Record of Affected Land <br />(cheek applicable box(s)): ?[$ Private ^ State ^ Federal ^ Indian <br />8. Type of Mining Operation <br />(check applicable box(s)): IOCa 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: Larimer <br />PRINCIPLE MERIDIAN chec one ~1 6th (Colorado) ^ 10th (New Mexico)^ Ute <br />TOWNSHIP (write number and check direction): T 4 YI North ^ South <br />RANGE (write number and check direction): R ~- ^ East 17 West <br />SECTION (write number): S 3~ <br />QUARTER SECTION (check one): ^~1~ ^ NW (~ SE ^ SW <br />QUARTER/QUARTER SECTION (check one): ^ NE ~ NW ^ SE ^ SW <br />GENERAL DESCRIPTION: <br />(miles and direction 7 miles north of Lvon^ on atone C any on Rd. <br />from nearest town and <br />approximate elevation) EistYation sop. 6.800 ft. <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 />