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III IIIIIIIIIIIII III . <br />LIMITED .~~~~.,.,~ 999..,,,..,,.. (110(2)) <br />RECLAMATION PERMIT <br />APPLICATION FORM <br />CHECK ONE: ~ New Application (Rule 3.2) _ <br />Conversion Application (Rule i.i0) <br />RECEI\/ED <br />DEC 0 61994 <br />Division of Minerals 8 Geology <br />Amendment Application (Rgule 1.8) <br />The application for a Limited Impact Operation Reclamation Permit contains three major <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 in this form. <br />__________________________________________________________________,._ _~~=1~_1=== <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, all information ,,escribed below. <br />1. Applicant/operator name: 1(./~~ 0/1~1J/!~7_ <br /> <br /> 1.1 Type of organization (corporation, partnership, etc.): ~ J?iiV ~~ ~ !~ <br /> <br />2. Operation name (pit, mine or site name>: L~/C~LZ l~/~°i~i~~' ~- ~~~~'~~~`/ r~ <br /> <br /> 2.1 I.R.S. Tax ID No. or Social Security No.: ~~~%y-Q~- (P?o, i7 <br /> <br />3. Permitted acreage /~, % 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): 3j~\, r% tiles. s iyN ~_ <br /> <br />5. Name of owner of surface of affected land: ~-~r/A/liU ~ /?29~t i l', ~~`''~ii%-' <br /> <br />6. Name of owner of subsurface rights of affected land: 1/~/Ai'i~) ~ /~Ii1~3~//. !/,at~;)•~-;- <br /> <br />7. Type of mining operation: ~' 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: ,//~~_~ <br />PRINCIPAL MERIDIAN (Check one>: 6th (Colorado) 10th (New Mexico) Ute __ <br />TOWNSHIP (write number and check direction): T z ~ North _ <br />South <br />RANGE (write number and check direction): R ~ _ East ~ West <br />SECTION (write number): S ~ <br /> <br />QUARTER SECTION (check one): . <br />NE <br />~~(NW f~SE <br />SW <br />QUARTER/QUARTER SECTION (check one>: _ <br />NE NW <br />SE _ <br />SW <br />GENERAL DESCRIPTION: _ _ <br />_ _ <br />(miles and direction ~, -~ rt~t it ~ ~ I~r~~i ltl t i~n~d !'Ai//n n~ 1~~ <br />from nearest town and <br />approximate elevation) ~~r r~ ,~Co /1~3A~ / dDA/,S. ~l1J~A~ lI <br />