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STATE OF COLOIZADO <br /> DIVISION OF RECLAMATION,MINING AND SAFETY <br /> Department of Natural Resources <br /> 1313 Sherman St,Room 215 <br /> Denver,Colorado 80203 COLORADO <br /> DIVISION o F <br /> Phone:(303)866.3567 RECLAMATION <br /> FAX:(303)832-8106 MINING <br /> SAFETY <br /> DESIGNATED MINING <br /> LIMITED IMPACT(I 10d)OPERATION n <br /> N O O <br /> RECLAMATION PERMIT APPLICATION FORM - o,3� <br /> a ri <br /> II <br /> III iV ,--10--4 CHECK ONE: Ness Application(Rule 14) Amendment Application(Rule I t or I lo) O l o <br /> Conversion Application(Ituic I i i) -,—r3 -,, <br /> n:�-1 <br /> Permit 4\tc=W/4 ° O (provide for Amendments and Conversions of existing permits) ':) .;;1:-x-'r-r- <br /> The application for a Limited Impact 110d Designated Mining pp p ( ) g g Operation Reclamation Permit contains three major parts: (1)the applisiation <br /> form;(2)Exhibits A-J,Exhibit L,Exhibit T,the Geotechnical Stability Exhibit,the Emergency Response Plan,and Addendum 1,as requt ed by <br /> the Office,and outlined in Rules 6.1,6.2,6.3,6.4.20 6 5,8,and 1.6.2(1)(b);and(3)the application fee. When you submit your application,be sure <br /> to include one(1)signed and notarized Original and one(1)copy of the application form,two(2)copies of Exhibits A-J,Exhibit L,Exhibit T,the <br /> Geotechnical Stability Exhibit(Rule 6.5),the Emergency Response Plan(Rule 8),and Addendum 1(Rule 1.6.2(1)(b)),as required,and a check for <br /> the application fee descnbed under(4)below Exhibits should VILT be bound or in 3-ring binders;maps should be folded to 8 2"X 11"or 8 2"X <br /> 14"size. To expedite processing,please provide the information in 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 or company name(name to he used on permit): Nevadaville Encore, LLC <br /> 1 1 Type of organization(corporation.partnership,etc.): LLC <br /> 1.2 I.R.S.Tax ID No.or Social Securit> Number: <br /> 2. Operation name(pit,mine or site name) Iron & Wm. Richardson Lode Claims <br /> 3. Permitted acreage(new or existing site): 0 permitted acres <br /> 3 1 Change in acreage(+) 1.0 acres <br /> Total Acreage in Permit Area 1.0 acres <br /> 4. Fees: (Rule 1.5) <br /> 4.1 New Application 52,875.00 application fee <br /> 4.2 Amendment Fee(operations existing as of 06 30/94) $1,725.00 application fee <br /> 4.3 Amendment Fee(operations permitted from 07,01/94) 52,300.00 application fee <br /> 4 4 After July 1,1995,to convert a 110(1), 110(2)or a 110 to a i 10(d),a new application form fora 110d must be submitted,along <br /> W ith an application fee of$2,875.00(Rule 1.1 1.2(2)). <br /> s. Primary commodities to be mined: Gold, silver <br /> G Type of mining operation Lj Surface III Underground ■In-situ <br /> Office of Office of <br /> Mined Land Reclamation Denver • Grand Junction • Durango Active and Inactive Mines <br />