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<br />~II II~II~II~II~~II~ REC'~I~ir-D <br />LIMITED IMPACT OPERATION (110(2)) F ES 9 ;°~4 <br />APPLICATION FORM <br />Ci. ~,,. 9~r- - ,~.. _, <br />The Application for a limited Impact Operation Reclamation Permit contains three ma;ior~gy <br />parts: (1) the Application Form, (2) the Application Exhibits A-F, and (3) the <br />application fee. When you submit your Application, be sure to include two sinned copies <br />of the Application Form, two copies of Exhibits A-F, and a check for the app ica ion fee <br />described under (4) below. To expedite processing, please provide the information in <br />the format and order described in this form. <br />__________________________________________________________~?==9 y= ~~ ~____=_________ <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, all information described below. <br />----------------------------------------------------------------------------------------- <br />----------------------------------------------------------------------------------------- <br />1. Applicant/Operator Name: Phillips Count <br />2. Operation Name (Pit, mine or site name): Johnson Pit <br />3. Application type: Limited Impact Operation (110). <br />4. Application Fee for Permitted Ac reaae* 9,9 permitted acres. <br /> (E10 x (affected acres) + E25.00).* <br /> Note permitted acreage and application fee and <br /> attach a check for this amount when you file. X75 application fee. <br />5. Substance(s) to be mined (e.a., gold/silver/gravel): Sand and eravel <br /> <br />6. Owners(s) of Substance to be Mined <br /> (check applicable box(s)): ~ Private _ State _ Federal _ Indian <br />7. Owner(s) of Record of Affected Land <br /> (check applicable box(s)): ~ Private _ State _ Federal _ Indian <br />8. Type of Mining Operation <br /> (check applicable box(s)): % Surface Underground In-situ <br />9. Location Information. The center of the area where the maiority of mining will <br /> occur lies in: <br />COUNTY: Phillips <br />PRINCIPLE c ec one 6th (Colorado) 10th (New Mexico) Ute <br />TOWNSHIP (write number and check direction): T 7N North South <br />RANGE (write number and check direction): R 47W _ <br />_ <br />East West <br />SECTION (write number): S 32 _ <br />_ <br />QUARTER SECTION (check one): -NE- x NW SE SW <br />QUARTER/QUARTER SECTION (check one): X NE X NW z SE - SW <br />GENERAL DESCRIPTION: _ <br />(miles and direction 6; miles south of Haxtun on Colo. 59: 1 mi le west <br />from nearest town and <br />approximate elevation) on Co. Rd. 16: ~ mi south on Co. Rd_ 3 ro nit <br />entrance <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 />