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o4�cotp <br />t�(n2r��+► <br />* 1876 <br />COLORADO DIVISION OF RECLAMATION, MINING AND SAFETY <br />1313 Sherman Street, Room 215, Denver, Colorado 80203 ph(303) 866-3567 <br />REQUEST FOR FULL OR PARTIAL RELEASE OF PERMIT AREA <br />Please indicate if you are requesting: <br />FULL/FINAL RELEASE OF ENTIRE PERMITTED AREA / <br />ACREAGE REDUCTION (PARTIAL RELEASE) c �O f <br />If you are requesting an acreage reduction, you will need to specify how many acres you wish to remove <br />from the existing permit under this revision. I wish to release acres at this time. <br />You will also need to submit updated mining and reclamation plan maps that accurately depict both the <br />proposed acreage to be released from the current permit area, and the resulting new permit boundary. <br />File No.: M- 1977 -163 -SG <br />County: <br />LINCOLN <br />Site Name: FISHER PIT <br />RECEIVED <br />Permittee: LINCOLN COUNTY JUN 2 5 2015 <br />SAME DIVISION OF RECLAMATION <br />Operator (If Other than Permittee): MINING AND SAFETY <br />Permittee Representative: J O H N D EWI TT <br />Certified Mail# 7008 1140 0000 4865 7261 <br />In accordance with Rule 4.17.1(2) the Operator shall include the names, addresses and phone numbers <br />of all owners of record to the affected land. Please attach additional sheets for this information if <br />required. <br />SHRINERS HOSPITALS FOR CHILDREN <br />PO BOX 31356 <br />TAMPA, FL 33631-3356 <br />Attn: TOM GUTHRIE <br />813-281-0300 <br />AF & Report <br />No Violations <br />NOTE: THE ACCESS ROAD THRU THE FISHER TO THE HOFFMAN PIT WILL REMAIN. <br />In accordance with Rule 4.17.1(4) the Operator or their agent MUST sign that they have complied with <br />the following statement: "All applicable portions of the Reclamation Plan requirements have been <br />satisfied in accordance with these Rules and all applicable requirements under the Act." <br />John DeWitt Digitally signed by loon DeWitt <br />DN:il =undue wn,o=UnrolnCounry.ou=�ndD�,OEM, JUNE 23, 2015 <br />email=ldanduse(dlincolncounryco.us, -US <br />Date: 2015.06.22 140226 -W00' <br />Signature of Permittee, Operator or their authorized agent Date <br />Important: In accordance with Rule 4.17.10 This release request must be submitted to the Division <br />via certified mail and separate from any other correspondence to the Division. <br />