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COLORADO RECEI�/ <br /> A7 ' <br /> `. Division of Reclamation, <br /> M FD <br /> Mining and Safety AR 2 ZO19 <br /> \!3Ip' D/17s/p� <br /> 1313 Sherman street,Room 215 'fW/H��CL <br /> Denver,Colorado 80203 �+,_ <br /> CONSTRUCTION MATERIALS �'�Yt•� <br /> SPECIAL OPERATION 111(1)(b) <br /> RECLAMATION PERMIT APPLICATION FORM <br /> The application for a Construction Materials Special 111 Operation Reclamation Permit contains four major parts: (1) the <br /> application form;(2)Exhibits A-L,Addendum 1,and any sections of Exhibit 6.5 (Geotechnical Stability Exhibit),as required <br /> by the Office, and outlined in Rules 6.1, 6.2, 6.3, 6.5, and 1.6.2(l)(b); (3)the application fee; (4)the Performance Warranty <br /> and Financial Warranty. <br /> When you submit your application,be sure to include one completed,signed and notarized ORIGINAL and one copy of the <br /> completed application form, two copies of Exhibits A-L, Addendum 1, appropriate sections of Exhibit 6.5 (Geotechnical <br /> Stability Exhibit), as required, a check for the 5400.00 application fee, and the fully executed Perfonnance Warranty and <br /> Financial Warranty. Exhibits should NOT be bound or in 3-ring binders;maps should be folded to 8 ''/z" X I or 8 %2"X 14" <br /> 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 be used on the permit): <br /> 1.1 Type of organization(corporation,partnership, etc.): ?v h..z / Y � �i- <br /> 2. Operation name(pit,mine or site name): f�� (�(�� / ii��/�/ v :;t <br /> 3. Permitted acreage: (must be 30 acres or less) Permitted Acres <br /> 4. Fees: <br /> 4.1 New Application 2 $400.00 Application Fee <br /> 5. Primary commoditie(s)to be mined: l �/ ✓ n �^ <br /> 6. Name of owner to the surface of affected land: <br /> 7. Name of owner to the subsurface rights of affected land: <br /> 8. Location informatlerw The center of the area where the majority of mining will occur: <br /> COUNTY: ;7 <br /> PRINCIPAL MERIDIAN(check one): 5_4 6th(Colorado) n 1 Oth(New Mexico) II Ute <br /> SECTION(write number): S <br /> TOWNSHIP(write number and check direction): T T J North F South <br /> RANGE(write number and check direction): � East West <br /> !,��NE <br /> QUARTER SECTION(check one): F-1— NW SE [5A_SW <br /> QUARTER/QUARTER SECTION(check one): 0_ NE E� NW _N SE 0_SW <br />