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OCT 171986 ~, <br />A i sOF.1 <br />~~~p'-!,?.. :~. '""••''tIMI7E~,IMPACT OPERATION (110) <br />,y~,tc. t?cF.. ~~~ !~''~'''"" 0"'~ APPLICATION FORM <br />This form contains two major parts: (1) General Operation Information <br />A-G. When you submit your application, be sure to include two si ned <br />General Operation Information, two copies of Exhibits A-G, and a~k <br />application fee described under (4) below. To expedite processing, pl <br />information in the format and order described in this form__m _~~_~/~ <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, •in the space provided, all information des <br />1. Applicant/Operator Name: /V2~SP/Ski <br />2. Operation Name (Pit, mine or site name): <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. Substance(s) to be mined (e. g., gold/silver/gravel): <br />"~i•o,1 <br />A <br />(2) Exhibits <br />es of the <br />the <br />provide the <br />~~5=L71_ ~J~ YL= <br />bed below. <br />~T <br />.Y/ <br />permitted acres. <br />g' <br />Z~~ application fee. <br />VQ <br />6. Owners(s) of Substance to be Mined ~ <br /> (check applicable box(s)): B" Private ^ State ^ Federal ^ Indian <br />7. Owner(s) of Record of Affected Land ~ <br /> (check applicable box(s)): ~" Private ^ State ^ Federal ^ Indian <br />8. Type of Mining Operation / <br /> (check applicable box(s)): 6 Surface ^ Underground ^ In-situ <br />9. Location Information. The center of the area where the majority o~f mining will <br /> occur lies in: <br /> COUNTY: /~ /~~:~~-- <br />~ <br /> PRINCIPLE MERIDIAN check one ^ 5th (Colorado) <br />Oth ( ew Mexic o)^ Ute <br /> TOWNSHIP (write number and check direction): T 3 4 Q' ~ <br />Jorth ^ South <br /> RANGE (write number and check di rection): R ~ <br />^ ast West <br /> SECTION (write number): _ <br />S 2 0 ~ <br /> QUARTER SECTION (check one): C~1d~ ^ NW ^ ,SE ^ SW <br /> QUARTER/QUARTER SECTION (check o ne): ^ NE ^ NW (S' SE ^ SW <br /> GENERAL DESCRIPTION: I <br /> <br />(miles and direction ~/ ! <br />f~,/!t)I'9~Ci/J~u~6/~f g/yJ~ I / <br />VE~f ,~ <br />DtRI~/I¢6 <br /> from nearest town and '~~ // <br /> approximate elevation) r <br />~,(~~ i V <br />, <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 />