PERMFILE138873

• Permit No: M1989112
• IBM Index Class Name: Permit File
• Doc Date: 10/24/1999
• Doc Name: FREE USE APPLICATION AND PERMIT VEGETATIVE OR MINERAL MATERIAL
• Media Type: D
• Archive: No

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Form SS IU-I
fMa} 19A5) UNITED STATES
DEPARTAIENTOFTHE INTERIOR
BUREAU OF LAND MANAGEMENT
FREE USE APPLICATION AND PERMIT
VEGETATIVE OR MINERAL MATERIAL
APPLICATION
FORA? APPROVED
ontR ~o. load-oool
E apires: Oauhcr il, 1987
Permit \umher
T~-co-crH-z-90
Ezpiratinn Date
j0-2~{-Q
District
C c11iD,
~amc of applicant Address (rnrlude rip rode)
Mnccxr Pnuurv RnAn TlroeoTrdGUT P.O. Box 66~ __
Kind of material Eaimamd yuan tiq•
Cerun A f,aevFl 150r000 YDS
OF
lOw'SSHIP I RANGE I SECTION I SIItlDIVISION
lON 103W 10
$WlSW! METES 8 BOUNDS
~ SEE EXHIBIT A ATTACHED)
Starr of COLORADO County of MOFFAT
Materials are to br used for ~ '
1 HER ER)' AGREE TO COMPLY w'ITH the special conditions as set forth below. 1 CERTIFY That the: (a) materials to be removed are to be used for the purpose noted
abose;(b) none of the materials remoz•ed ere to be sold or bartered; (c) removal of materials can bcginonly upon receipt of an approved copy of this permit; end, (d)the
authorized officer is to be notified upon completion of removal.
I CE R71 F)' That 1 am a citizen of the United States, and of the egr of majority in the State in which 1 reside.
I FURTHER CE RTIFI' That the statements made oy' me in this application are trot, complete, and correct to the best of my knowledge and belief and are made in good
faith.
OCTOBER 1)r 1989
(Darr)
FFA
OAD~EPARTMENT
Tide 18 U.SC. 5¢tion 1001, makes it a crime for any person knowingh' and will(ull)' Io male io am' depan mein or agency of the Umtnd gams any false, Unitious, or fraud ulem sutemrms or
rrprracnwions>io aq~mauer wiihm iujuriWiaion. '
PERMIT
SPECIAL CONDITIONS
This permit is hereby' issued for the materials applied for hw ma}' be canceled if it appears that this permit was issued erroneously or the corms or conditions contained
herein are not obsen'ed It shall 6c subjen to the following special conditions:
See ~C-JC~1\~Jl"~ ~, Q~Cv\P~ ~ .
Information is collected w comply with Statures (16 U.S.C. 604-606 and agenn~ Regulations (43 CFR 5511.1-Ile)).
Information is used to confirm the residence of the applicant.
Apphcam murr respond to obtain a permit.
Consen'ation practices coon bt carried out as provided b}' d3 CFR 5511.1-Ifb),
.2-3(c1, and .J-J;
Equipment, personal proputy, and improscmcros murr be removed within
nines} 190) days after expiration date 47 CFR 551 L3-5);
Am tnc of the surface of the lands ins'olrcd in this permit shall be such as not to
in¢r&rr with am mining claim subject to the provisions of Section d of the Act of
July 23. 1955 (30 U.S.C. 61 J):
The permitlee shall clean up all work areas and shall remove or dispou of all
refuse resulting from the p<rminee's operations;
This p<rmit is issued under the Act of July 31, 1947, as amended, and d3 U.S.C.
and 1201, and under the free use privilege of the Act of May Id, 1898 (Alaska).
An annual report indicating the amount (cu. yds. or Ions) of material removed
murr be filed with the Distrin 0f6ce on the anniversary date o(thc permit, or
within thirty (30) days afmr p<rmit expiration.
~.
' _
~ J
( arc) y -v (Signamrc of Amhorized Officer)
APPLICANT