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EE. 28 '95 15:15 FROM MI~ MOTION MFG - TO 9-63 106 PAGE.003i004 <br />III IIIIIIIIIIIII III <br />999 <br />LIhiI~ED IMPACT. OPERATION (110(2)) <br />RECLAMATION PERMIT <br />APPLICATION FORM <br />CHECK ONE: ~ New Application (Rule 3.2> Amendment Appllcation (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 />f•ee described under (3) below. To expedite processing, please provide the information <br />in the format and order described in this form. <br />_-====z======z=°°==_~------=-=====r==='°~~~_°~__~______~_~~______________°__°_____------_ <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, all information described below. <br />1 . Applicant/operator name: ~f~~/l~ 1~~/FZ <br />1.1 Type of organization (Corporation, partnership, etc.): ~/J'' /~S~ <br />2. Operation name (pit, mine or site pame): ~~/~j ~~iPSf//ate <br />2.1 I.R.S. Tax ID No. or Social Security No.: ~~Y ~~ ~~ ~~~ <br />3. Permitted acreage `, y permitted acres <br />3.1 Application Fee (New Appllcation Only) 8875.00 application fee <br />4. Substance(s) to be mined (e.g., gravel/gold/borrow>: llrl~ ,~/l~l. S(/~A/,'~_ <br />5. Name of owner of surface of affected land: ~~t/~/r/D~ i~/Y~~~~ /~f _ <br />6. Name of owner of subsurface rights of affected land: <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 />COUNTY: ~~~~ <br />PRINCIPAL MERIDIAN (check one): 6th (Colorado) 10th (New Mexico) Ute <br />TOWNSHIP (write number and check direction): T ~ ~ North South <br />RANGE (write number and check direction): R Zf _ East ,~ West <br />SECTION (write number): S <br />QUARTER SECTION (check one): `flE ~Nw ~ SE _ Sw <br />QUARTER/QUARTER SECTION (check one): _ NE _ NW _ SE _ SW <br />GENERAL DESCRIPTION: ~~ t~ <br />(miles and direction ~,~ /~~/~,S /YOIT//~ /~~3 .~~i~Dt/ [Y <br />from nearest town and ~ ,/ <br />approximate elevation) ~' //,_S ~(o A~i /1/D~S //,Y/)~i.9[~C~ <br />