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L. f C1 '7-7 07/ <br /> Pvi'' Application Checklist <br /> j,,, ,tt, ,-'),b).- Di'--v?s Er-Application Form: Complete the form located on page 5. <br /> 5'2"/ 01/ ❑ Application Fee: Include check payable to Colorado Division of Reclamation. Mining <br /> and Safety. <br /> ;1�+ 7 a--------- „,,,'W Performance Warranty: Complete the form located on page 11. <br /> N)121/1--4 <br /> ) Er-Financial Warranty: Submit the appropriate Financial Warranties or conditional <br /> (/v)-f�,, 4 replacement Financial Warranties using the forms posted on the Division's \\ebsite <br /> ak,A. ' °= .. (t\Irituble online at fifth: niiniii .,tate.co.u,, \lincral",,201 oruu•.htni). <br /> j-""-- \ rt 'Demonstration of Legal Right to Enter: Identil\ the oN\ners of all surface and mineral <br /> Er-'in�nr vq�, Q rights. obtain the documentation described above, and submit to the Dig ision. <br /> I°i.4)'iY <br /> Structure Agreements: Obtain ne« Structure Agreements if Permittee had been required <br /> to do so. <br /> ti�/ i'Nr2x/tiDvt iQi ‘.7ttCL <br /> -4- At _ RECEIVED <br /> 6a'� r Y ,di f'ru- <br /> fit <br /> ,P,,,-1,/ ,.y� i it'd 6,-(kZG� ..tai /z�3��G/� R <br /> FEB 0 8 2019 <br /> L1, 5u.'tJ 'P-ir h - 5�s ;e 5 �n, 4 o f e 4A, r <br /> DIVISION OF RECLAMATION <br /> rvy 4_a Gi}` r ea404 v,i1e,/m i-f d G-5 MINING AND SAFETY <br /> _ N'ilf(Itt/ V(P (P/A1711.. <br /> 1-1118 ,PO/P ,)714////k M cr-erxic 0/1 <br /> -4 - <br />