PERMFILE135183

• Permit No: M1978007
• IBM Index Class Name: Permit File
• Doc Date: 5/27/1975
• Doc Name: FREE USE APPLICATION & PERMIT VEGETATIVE OR MINERAL MATERIAL
• Media Type: D
• Archive: No

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Form 5510-1 t UNITED,ATES CJL'. :,'•%-~"~ U;; ``.;".~r•
(day 1972) DEPARTMENT OF THE INTERIOR
BUREAU OF LAND MANAGEMENT
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FREE USE APPLICATION AND PERMIT
VEGETATIVE OR MINERAL MATERIAL
APPLICATION
Name of applicant Address (include zip cod.
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Illllllllllllllllll
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Permit Number
' Expiration Date Feb. 17, 19f!
District
Kind of materiel I Estimated quantity"-
Pit Run or Crus>zs~ Peek - 1o0.~OJ f'n_ ~r~s_
Give legal land description
7OWNSHIP RANGE SECTION ~ SUBDIVISION
1iN. 101. 28 ~ 33
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SeC. ?~7 J.T..S vh;~ J
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52 JL4 .r
54+,
Sec 33 N~ Nn' P*'3
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Materials are to be used Lor
S~:facing on Covnty Roads
I HEREBY AGREE TO COMPLY WITH the special conditions es set Earth below. I CERTIFY That the: (e) materiels
to be removed ere to be used for the purpose noted above; (b) none of the materiels removed are to be sold or bartered;
(c) removal of materiels can begin only upon receipt of an approved copy of this permit; andt (d) the authorized officer
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is to be notified upon completion of removal. ~, ~.. ~ ~ ~
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I CERTIFY That I am twenty-one years of age or older, a citizen of fhe United States, and resident of the State of
Colorado
I FURTHER CERTIFY That the statements made by me in this application ere true, complete, and correct to the best
of my knowledge and belief end ere made in good faith.
2/i 7/'75 ~ -: %f% ~/f'~ (3v~erviso;
(Date) ~ (Signature of Applicant)
Titie 18 U.S.C. Section 1001, makes it a crime (or any person knowingly end willfully to make to any department or agency of the
United Stetea any false, fictitious, or fraudulent statements or repreeentatlane •a to any matter within 1ta juriadictioa. .^. '' ~ .. ~
PERMIT
SPECIAL CONDITIONS -
This permit is hereby issued for the materials applied for but may be canceled if it appears that this permit was
issued erroneously or the terms or conditions contained herein are not observed. It shall be subject to the following_
special conditions:
See R~Etc~ied S~iee.~
Conservation practices must be practiced as provided
by 43 CFR 5511.1-1(b), .2-3(c), and .3-3; -.. _ _
Equi~t5t~~~rsona7 property, and improvements tnust-
be removed within ninety (90) days after expiration
date (43 CFR 3621.3(c) or 5511.3-5);
Any use .of the surface of the lands involved in. this
permit shall be such as not to interfere with anymining.
claim subject to the provisions of Section 4 of the Act
of July 23, 1955 (30 U.S.C. 613);
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~The.permittee shall clean up all, work areas end shall
~~remove or dispose of all refuse _resulting from-the
- permittee's operations;-.--'._`-'"-_ _ _
This permit is issued under the Ad of July 31, 1947,
as amended, and 43 U.S.C. 2 end 1201.
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