Laserfiche WebLink
RECEIVED <br /> ' COLORADO <br /> Division of Reclamation, JAN 2 9 2016 <br /> Mining and Safety <br /> 1313 Sherman Street,Room 215 �A1D8Af W <br /> Denver,CO 80203 <br /> LIMITED IMPACT OPERATION(I10(1)) <br /> RECLAMATION PERMIT <br /> APPLICATION FORM <br /> CHECK ONE: 1 I New Application F] Conversion Application(Rule 1.11) <br /> Permit# M-2016-002 _ (provide for conversions of existing permits) <br /> The application for a Limited Impact 110(l) Mining Operation Reclamation Permit contains three major parts: (1)the application form; <br /> (2)Exhibits A-J,any required sections of Exhibit S and Geotechnical Stability Exhibit,as required by the Office,and outlined in Rules <br /> 6.1, 6.2, 6.3,and 6.5;and(3)the application fee. When you submit your application,be sure to include one (1)signed and notarized <br /> original and one(1)copy of the application form,two(2)copies of Exhibits A-J,and 6.5(Geotechnical Stability Exhibit),as required and <br /> a check for the application fee described under(4)below.Exhibits should not be bound or in a 3-ring binder;maps should be folded to 8 <br /> 1/2"X 11"or 8 12"X 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 /> I. Aualicant/oaerator or company name(name to be used on the uermit): Donald J. Self <br /> 1.1 Type of organization(corporation,partnership,etc.): <br /> 2. Ooeration name(oit,mine or site name): Double Eagle <br /> 3. Permitted acrea¢e(must be 5 acres or less): 3 permitted acres <br /> 4. Fees: <br /> 4.1 New Application $288.00 application fee <br /> 4.2 Amendment Application $661.00 amendment fee <br /> 4.3 Conversion Fee(from I10(2)to l I0(l),(Rule 1.11.2(2)) $288.00 conversion fee <br /> 5. Primary commodities)to be mined: Feldspar and Quartz <br /> 6. Name of owner to the surface of affected land: Donald J. Self <br /> 7. Name of owner to the subsurface riehts of affected land: Donald J. Self <br /> Ty pe 8. Tyne of mining oration: 17 1 Surface ]a Underground F]Placer <br /> ov (()4 <br /> 1313 Sherman Street, Room 215,Denver,CO 80203 P 303.866.3567 F 303.832.8106 http://minirvg.state.co.us <br /> John W.Hickentooper,Governor I Mike King,Executive Director I Virginia Brannon,Director .1876 <br />