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- IIIIIIIIIIIIIIIIIII • RECEIVED <br />LIMITED IMPACT OPERATION (110(2)) N~~ lJ 2 1Q44 <br />RECLAMATION PERMIT <br />APPLICATION FORM <br />Division of Minerals & Geology <br />CHECK ONE: X New Application (Rule 3.2> Amendment Application (Rule 1.8) <br />Conversion Application (Rule 1.10) <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 pr vide the information <br />in the format and order described in this form. ~_ ~ ~_~' <br />---------------------------..- GENERAL OPERATION INFORMATION =-~----~-----a====-=»oao=~~ <br />Type or print clearly, in the space provided, all information described below. <br />CO6~Jp i C 7 Y C7 C O i '3 ~! O O OCC <br />1. Applicant/operator name: Fremont County Board of County Commissioners <br />1.1 Type of organization (corporation, partnership, etc.): Governmental Entity <br />2. Operation name (pit, mine or site name): Fremont County's Phantom Canyon Gravel Pit <br />2.1 I.R.S. Tax ID No. or Social Security No. <br />3. Permitted acreage 9.a 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): Gravel <br />5. Name of owner of surface of affected land: State Board of Land Commissioners <br />6. Name of owner of subsurface rights of affected land: Same as above <br />7. Type of mining operation: X 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: Teller <br />PRINCIPAL MERIDIAN (check one): X 6th (Colorado) 10th (New Mexico> Ute <br />TOWNSHIP (write number and check direction): T 16 North X South <br />RANGE (write number and check direction): R _ <br />69 East X West <br />SECTION (write number): S _ <br />16 <br />QUARTER SECTION (check one): NE NW X SE SW <br />QUARTER/QUARTER SECTION (check one): _ <br />NE X NW <br />5E _ <br />SW <br />GENERAL DESCRIPTION: _ _ _ <br />(miles and direction Approximately 6 miles Southeast of Victor; <br />from nearest town and <br />approximate elevation) 9,085 feet <br />ORIGINAL <br />- .~ .__. __. ~ u _~ . __. <br />