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,- . ~ _ ~ iii iiiiiiiiiiiiiiii ~-~~ - __, • . ~. <br />LIMITED IMPACT OPERATION (110(2)) ~'ri'8di_ZnG <br />APPLICATION FORM Reclamation ::ivaion <br />The Application fora limited Impact Operation Reclamation Permit contains three major <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 apo_Ticafion fee <br />described under (4) 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: Douglas y. watrous <br />2. Operation Name (Pit, mine or site name): Mendota Properties <br />3. Application type: Limited Impact Operation (110). <br />4. Application Fee for Permitted Ac reaae* g,g 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. $125.00 application fee. <br />5. Substance(s) to be mined (e.a., gold/silver/gravel): Ag, Au, Pb, zn, Cu ~ <br /> Aggregate <br />6. Ownersfs) of Substance to be Mined <br /> (check applicable box(s)): g Private State Federal Indian <br />7. Owner(:;) of Record of Affected Land <br /> (chE>ck applicable box(s)): ~ Private _ State _ Federal _ Indian <br />8. Type o1' Mining Operation <br /> (check applicable box(s)): X Surface x Underground In-situ <br />9. Location Information. The center of the area where the majority of mining will <br /> occur lies in: <br />C[IUNTY: Clear Creek <br />PRINCIPLE c ec one x 6th (Colorado) 3~D~XX)f6oX7~XN4~XX <br />T(IWNSHIP (write number and che ck direction): T 4 North X South <br />RANGE (write number and check direction): R 75 _ <br />East X West <br />SECTION (write number): S ~ 7~ _ <br />OIIARTER SECTION (check one): ~E NW <br />SE x SW <br />QUARTER/QUARTER SECTION (check _ <br />one): NE _ <br />_ <br />NW SE SW <br />GENERAL DESCRIPTION: S Section 13, SE 1/4- <br />(rtiiles and direction Adjacent to the North and West of the <br />from nearest town and <br />approximate elevation) Town of Silver Plume, Colorado. . <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 />