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~ ~ III IIIIIIIIIIIIIIII ~ ~~.~ ~~~~~~ <br />MAY 2 U 1987 <br />MINED LAND l <br />~' [DECLAMATION DIVISIO~ <br />LIMITED IMPACT OPERATION (110) / <br />APPLICATION FORM <br />This form contains two major parts: (1) General Operation Information and (2) Exhibits <br />A-G. When you submit your application, be sure to include two signed copies of the <br />General Operation Information, two copies of Exhibits A-G, and a- c~ieck for the <br />application 'fee described under (4) below. To expedite processing, please provide the <br />information 'in the format and order described in this form. <br />____________ _______________________________________________1~1=~7-R~ =ASK=~~ ~r273 <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, all information described below. <br />1. Applicant/Operator Name: Tordan C. or Jone L. Bu rdlck <br />2. Operation Name (Pit, mine or site name): B & G Stone <br />3. Application type: Limited Impact Operation (110). <br />4. Application Fee for Permitted Acreage* <br />(E10 x (affected acres) + $25.00).* <br />Note permitted acreage and application fee and <br />attach a check for this amount when you file. <br />5. Substance(s) to be mined (e. g., gold/silver/gravel) <br />6. Owners(s) of Substance to be Mined <br />(checfc applicable box(s)): <br />7. Owner(s) of Record of Affected Land <br />(check applicable box(s)): <br />8. Type of Mining Operation <br />(check applicable box(s)): <br />>{% Private <br />5 permitted acres. <br />$75.00 application fee. <br />Fl:~g Stone <br />i;~ State ^ Federal ^ Indian <br />X$ Private ^ State ^ Federal ^ Indian <br />XXX Surface ^ Underground ^ In-situ <br />9. Location Information. The center of the area where the majority of mining will <br />occur lids in: <br />COUNTY: Larimer <br />PRINCIPLE MERIDIAN c ec one Z] 6th (Colorado) ^ 10th (New Mexico)^ Ute <br />TOWNSHIP (write number and check direction): T 4 ~) North ^ South <br />RANGE (write number and check direction): R -70- ^ East X] West <br />SECTION (write number): S -3T- <br />QUARTER SECTION (check one): ^-AE- ^ NW L~ SE ^ SW <br />QUARTER/QUARTER SECTION (check one): ^ NE ® NW ^ SE ^ SW <br />GENERAL DESCRIPTION: <br />(miles and direction 7 mllee north of Lvon a on >3tone Canyon Rd <br />from nearest town and <br />approximate elevation) ElreYation aop. 6.800 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 />