Laserfiche WebLink
STATE OF COLORADO <br />DIVISION OF RECLAMATION, MINING AND SAFETY <br />Dgwtrnent d Nah nl Resources <br />1313 Sherman 5L, Room 215 <br />Denver. Colorado 80203 <br />Phone: 003) 6663567 <br />FAX: 003) 8324106 <br />LWHED IMPACT OPERATION (110(2)) <br />RECLAMATION PERMIT <br />APPLICATION FORM <br />CHs: —O New Application (Rule 14) 0 Conversion Application (Rule 1.11) <br />Permit # (provide for conversions of existing permits) <br />COLORADO <br />DIVISION at <br />RECLAMATION <br />MINING <br />SAFETY <br />The application for a Limited Impact Designated Miming Operation Reclamation Permit contains three mgjor parts: (1) the application <br />fora; (2) Exhibits A -I, any required awdons of Exhibit S and Geowbdcal Stability Exhib% as required by the Office, and outlined in <br />Rules 6.1, 6.2, 63.6.4.19 and 6.5; ggd (3) the application fee. When you submit your application, be sure to include one (1) s1gMd gW <br />notarized original and one (1) copy of the application form, two (2) copies of Exhibits A-], appropriate sections of 6.4.19 Exhibit S and 6.5 <br />(Geotechnical Stability Exhibit), as required, and a check for the application foe described Calder (4) below. Exhibits should ad be bound <br />or in a 344 binder maps should be folded to S 1/2" X 11" or 91/2" X 14" size. To expedite processing, please provide the information <br />in the format and order described in this form <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, In the apace provided, all information described below <br />1. Antleant/oDerator or Swoanv name (aamae to be aced on the nermltl: sic- l D3 ► a>`. <br />1.1 Type of organization (corporation, partnership, etc.): r,,+i oh <br />2. ODeradon name (o1 going or site nanM; sief- I t X <br />3. Permitted aerieIre (new or "huge dtd: 3.0'9 0Xt4� �►� cactes �a-rY� �' j s � a'1c pitted acres <br />4. Fees.. <br />4.1 New Application SIA".00 application fee <br />4.2 Amendment Application (from 1.10(2)) <br />4.3 Conversion Fee (from 110d to 110(2), (Rule 1.112(2)) S1•725.00 conversion fee <br />S. Pdmary commodttletil to be mined• G04 5 10 er CIl4 e K+i ALL m 9 ro&4e WhjP+A j ' <br />6. Name of owner to the surface of affected land; u 5, r'D r e S-t Se- C U t 1-t <br />7. Name of owner to the subsurface rights of I fled land: P 1 1 p E, <br />8. Twe of mlaIm operation: ® Surface ❑ Underground ❑ In -situ <br />Opined officeof <br />Mined Lund Radunatlora Dower • Grand JunNon •Our o Active and traective Mhm <br />