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;~ ~ III IIIIIIIIIIIIIIII <br />~ * RECEo~~~=~ ; <br />LIMITED IMPAC7 OPERATION (110(2)) JUL 0 1 1991 <br />RECLAMATION PERMIT <br />APPLICATION FORM Mined ~ancS <br />Reclamation Division <br />The application for a Limited Impact Operation Reclamation Permit contains three major <br />parts: (1) i;he application form; (2) Exhibits A-J; and, (3) the application fee. When <br />you submit your application, be sure to include two (2) signed originals of the <br />application form, two (2) copies of Exhibits A-J, and a c~for the application fee <br />described under (3) below. To expedite processing, please provide the information in <br />the format and order described in this form. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, all information described below. <br />1. Applicant/operator name: <br />1.1 Type of organization (corporation, partnership, etc.): Local Government <br />2. Operation name (pit, mine or Site name): PETERS PIT <br />2.1 I..R.S. Tax ID No. or Social Security No.: <br />3. Application fee for permitted acreage* 9.6 permitted acres <br />(525..0(1 + 10/acre)* <br />Note permitted acreage and application fee and <br />attach a check for this amount when you file. application fee <br />4. Substanc:e(s) to be mined (e.g., gravel/gold/borrow): Gravel <br />5. Name of owner of surface of affected land: JartES E. PETERS <br />6. Name of owner of subsurface rights of affected land: 1nMES E. PETERS <br />7. Type of mining operation: x Surface _ Underground i In-situ <br />8. Location information. The center of the area where the majority of mining will <br />occur lies in: <br />COUNTY: Crowley <br />PRIN(:IPAL MERIDIAN (check one): 6th (Colorado) 10th (New Mexico) Ute <br />TOWNSHIP (write number and check dirion): 7 20 North ,~-South <br />RANGE: (write number and check direction): R 55 _ East y~ West <br />SECTION (write number): S 25 <br />QUARTER SECTION (check one): CIE NW ~ SE SW' <br />QUARTER/QUARTER SECTION (check one): _ NE X NW _ SE ~ SW <br />GENEF:AL DESCRIPTION: <br />(mllE!s and direction From Haswell, 20 miles West on_hishwa~c95~r„rn ., <br />from nearest town dnd ~ o~a~ North, 1 mile, then West 1/2 + miles. <br />approximate elevation) <br />* A fraction of an acre mist be counted as one acre for fee calculation. If the <br />operator is e~ unit of state or county government, an application fee is not required. <br />