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? nuniuin?wm <br />I <br /> <br /> <br />LIMITED IMPACT OPERATION (110(2)) <br />APPLICATION FORM <br />RECEIVED <br />OCT 0 9 1990 <br />Mined Lance <br />Reclamation Division <br />The Application for a Limited Impact Operation Reclamation Permit contains three major <br />parts: (1) the Application Form, (2) the Application Exhibits A-F, and (3) the <br />application fee. When you submit your Application, be sure to include two signed copies <br />of the Application Form, two copies of Exhibits A-F, and a check for the app ca ion fee <br />' described under (4) below. To expedite processing, please provide the information in <br />the format and order described in this form. M:?l_r=?3?a====135 <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, all information described below. <br />' 1. Applicant/Operator Name: James H. & Kathleen H. T'4ss <br /> 2. Operation Name (Pit, mine or site name): Ross 10it <br /> 3. Application type: Limited Impact Operation (110). <br /> 4. Application Fee for Permitted Acreage* 9.52 permitted acres. <br /> ($10 x (affected acres) + $25.00).* <br /> Note permitted acreage and application fee and <br /> attach a check for this amount when you file. "130.20 application fee. <br /> 5. Substance(s) to be mined (e.g., gold/silver/gravel): sxavel <br /> 6. Owners(s) of Substance to be Mined <br /> (check applicable box(s)): x Private State _ Federal _ Indian <br /> 7. Owner(s) of Record of Affected Land <br /> (check applicable box(s)): x Private _ State , Federal _ Indian <br /> 8. Type of Mining Operation <br />' (check applicable box(s)): x 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: : Moffat <br /> PRINCIPLE MERIDIAN c ec one : 6th (Colorado) 10th (New Mexico) Ute <br /> TOWNSHIP (write number and check direction): T 6 x North South <br />- <br />_ <br />- <br />' gam <br />West <br />East X <br />RANGE (write number and check direction): R <br /> SECTION (write number): S 3 <br /> QUARTER SECTION (check one): -K- x NW SE SW <br /> QUARTER/QUARTER SECTION (check one): NE NW X SE X SW <br /> GENERAL DESCRIPTION: a portion of the Saj,713., S{T :dF3y, ivF}Si of Sec. 3, T&4, "9%7, <br /> (miles and direction 5 rini_pS agt- of (Irai_Q? Cola- <br /> from nearest town and <br /> approximate elevation) 62(X} 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 />' Z