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ECEIVED <br />LIMITED IMPACT OPERATION (110(2>) NOV 0 3 1994 <br />RECLAMATION PERMIT <br />APPLICATION FORM <br />Division of Minerals & Geology <br />CHECK ONE: x New Application (Rule 3.2> Amendment Application (Rule l.8) <br />Conversion Application (Rule 1.10) <br />The application for a Limited Impact Operation Reclamation Permit contains three ma]or <br />parts: (1) the application form; <2) Exhibits A-J; and, (3) the application fee. When <br />you submit your application, be sure to include one (1> signed original and one (1) copy <br />of the application form, two (2> copies of Exhibits A-J, and a check for the application <br />fee described under (3) below. To expedite processing, please provide the information <br />in the format and order described to this form. C~L.F_ dqC~ <br />GvvCGVFivviiaiiCivaCGCViiCGCVCaCCGGVViCGGiGGGCavFiiCVVaFGVaGCC~GCaaGFGaaCGGa`-aFGGaaaaaa <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, all information described below. <br />OciGOVFaavFGVFCViFCVFCCCViCFVVVaiCiG0vOC3FGCCCCCFCCVaaaFaFOGGVaaCGGCVCCCGCCCFCCGGaaOGCGCa <br />Applicant/Operator name: Fremont County Board of County Commissioners <br />1.1 Type of organization (corporation, partnership, etc.>: Governmental Entity <br />2. Operation name (pit, mine or site lldlne):Fremont County's Iron Mountain Road Gravel Pit <br />2.1 I.R.S. Tax ID No. or Sociai Security No.: <br />3. Permitted acreage 9.8 permitted acres <br />3.1 Application Fee (New Application Only) $875.00 application fee <br />4. Substance(s) to be mined (e.g., gravel/gold/borrow>: Gravel <br />5. Name Of Owner Of SUrfdCe Of affected land: Bureau of Land Management <br />6. Name of owner of subsurface rights of affected land: Bureau of Land ranagement <br />7. Type of mining operation: x Surface _ Underground _ In-situ <br />8. Location information. The center of the area where the majority of mining will <br />occur lies in: <br />COUNTY: Fremont <br />PRINCIPAL MERIDIAN (check one): x 6th (Colorado) loth thew Mexico) Ute <br />TOWNSHIP (write number and check direction): T 19 _ North x South <br />RANGE (write number and check direction): R 72 _ East x West <br />SECTION (write number): S 32 <br />QUARTER SECTION (check one): _ NE x NW SE _ SW <br />QUARTER/QUARTER SECTION (check one): _ NE _ NW x SE SW <br />GENERAL DESCRIPTION: <br />(miles and direction gpproximately 2B miles Southwest of Canon City <br />from nearest town and <br />approximate elevation) ~_soo feet <br />OR~GO~AL <br />