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'~';;. LIMITED IMPACT OPERATION (110(2) ) <br />r; RECLAMATION PERMIT <br />s! ~~~~ APPLICATION FORM <br />~~The'3pPit,catlon for a Llmtted Impact Operation Reclamation Permit contains three mayor <br />;?`,partS?~"(1) the application form; (2> Exhibits A-J; and, (3> the application fee. When <br />'t`;;yo4 Submit your application; be sure to include two (2) signed originals of the <br />.~: appl.~tatton form, two <2) copies of Exhibits A-J, and a check for the application fee'..: <br />'~;. de;crlbed under (3) below. To expedite processing, please provide the information in " <br />the format and order described in this form. <br />vvvvvvavvvvvvavvvvvvvavaavvvvvvvaaavvvvavvvvavvvvavvvvavvvavvvvvvvvvvvvvvvvvvvvvvvvv~w va <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, 1n the space provided, all information described below. <br />vvvvw vvvw vvvvvvavvvavvvaaavaaaasaasaaavvvaa as anaan vav vvvvavvvvvvvvvvvvvvvvvvavvvvvvv~~~ <br />k <br />r - .2. <br />~':' <br />,'. <br />..: <br />'Applicant/operator name: ~iy1~NK-~/~ <br />1.1 Type of organization (corporation, partnership, etc.): 7n/ D/ //.OL/AlL Y-- <br />Operation name Cpit, mine or site name): (Yc76,11 ~A S/N '- <br />2.1 I.R.S. Tax ID No. or Social Security No.: <br />i..• 3. Permitted acreage -~ permitted acres <br />i' <br />~;:.: <br />3.1 Applfcatlon Fee 5875.00 application fee <br />,~: <br />~~.. .4. Substance(s) to tie mined (e.g., gravel/gold/borrow): (TfJ~ A - __ <br />5. Name of owner of surface of affected land: .~ VF7rY ~/.9 • <br />,,, 6. Name of owner of subsurface rights of affected land: T//YII/s~//E L~ <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 />t. COUNTY: Ct~f~ffEF <br /><: <br />PRINCIPAL MERIDIAN (check one): X 6th (Colorado) 10th (New Mexico) Ute <br />'~" TOWNSHIP (write number and check direction): T ~ North ~ South <br />•~ RANGE (write number and check direction): R QO _ East •~ West <br />y`~~ SECTION (write number): S <br />•:~ QUARTER SECTION (check one): ,'~ NE _ NW SE _ SW <br />=~ '. QUARTER/QUARTER SECTION (check one): _ NE _ NW ,~ SE _ SW <br />~"• GENERAL DESCRIPTION: <br />t ~ (miles and direction ~.S/~/,LFS bt/~ST-~DF GRIN/TE <br />~' ^ ~.'_. from nearest town and ^"- <br />approximate elevation) /a ~D Ff •`, <br />~` <br />!' <br />,:• <br />~•` <br />v. <br />'~ <br />~F: .,.7:;W .. <br />