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ill tl{Il{11111{{III o RECEIVED <br />' 999 <br />a OCT 0 9 1990 <br />' LIMITED IMPACT OPERATION (110(2) ) Mined Lana APPLICATION FORM 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 ?ned copies <br />of the Application Form, two copies of Exhibits A-F, and a check for the ap-pTication fee <br />' described under (4) below. To expedite processing, please provide the information in <br />the format and order described in this form. M. clL-) - t 3 <br />=a:z===a=====p====a==.===nee====c====aaa===ae====ca__=e== =_=_ve?== ___=e=====.___.___ <br />GENERAL OPERATION INFORMATION <br />1 Type or print clearly, in the space provided, all information described below. <br />1. Applicant/Operator Name: Janes H. & Kathleen H. '?oss <br />2. Operation Name (Pit, mine or site name): Ross nit <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. X130.20 application fee. <br />5. Substance(s) to be mined (e.g., gold/silver/gravel): Travel <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 i 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: '4offat <br /> PRINCIPLE MERIDIAN (c hoc one 6th (Colo rado) 10th (New Mexico) Ute <br /> TOWNSHIP {write number and check direction): T 6 x North South <br />'- <br />_ <br />i RANGE (write number and check direction): East x West <br />R <br />71F <br /> SECTION (write number): S 3 <br /> QUARTER SECTION (check one): '-RE - x NW SE SW <br /> QUARTER/QUARTER SECTION (check one): x NE NW x SE x SW <br /> GENERAL DESCRIPTION: a portion of the SaJ,11-19;, SAP,;k iVF}Si of Sec. 3, 'T'613, R901-71 <br /> and direction 5 nilpc act of rraic, Cnlo_ <br /> from nearest town and <br />' <br />approximate elevation) 62M - <br />ft-- <br /> if the operator is a unit of State or county governme nt, an application fee is not <br />' required. A fraction of an acre must be counted as one acre for fee calculation. <br />•' Z