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COL <br /> Divisic RECEIVED <br /> MinincM2019-029 Departme MAY 2 4 2019 <br /> 1313 Sher <br /> Denver,c JLE/mac <br /> D St i F RECLAI44q>70{� <br /> CONSTRUCTION MATERIALS MlN1fV�AND SAFETY <br /> SPECIAL OPERATION 111(1)(b) <br /> RECLAMATION PERMIT APPLICATION FORM <br /> The application for a Construction Materials Special I I I 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 $400.00 application fee, and the fully executed Performance Warranty and <br /> Financial Warranty. Exhibits should NOT be bound or in 3-ring binders;maps should be folded to 8 ''/z"X I I"or 8 ''/z"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 /> LGI Homes-Colorado, LLC <br /> 1.1 Type of organization(corporation,partnership,etc.): Colorado limited liability company <br /> 2. Operation name(pit,mine or site name): Borrow Site for Bennett Crossing Filing 2(Parcel 1) <br /> 3. Permitted acreage: (must be 30 acres or less) 25.90 Permitted Acres <br /> 4. Fees: <br /> 4.1 New Application $400.00 Application Fee <br /> 5. Primary commodities)to be mined: Dirt and earthen material <br /> 6. Name of owner to the surface of affected land: Rick Mitchell and Elizabeth Mitchell <br /> 7. Name of owner to the subsurface rights of affected land: Rick Mitchell and Elizabeth Mitchell <br /> 8. Location information: The center of the area where the majority of mining will occur: <br /> COUNTY: Adams <br /> PRINCIPAL MERIDIAN(check one): FV7L_I_ 6th(Colorado) F-1 10th(New Mexico) F1 Ute <br /> SECTION(write number): S 27 <br /> TOWNSHIP(write number and check direction): T 3S F-1 North FV71 South <br /> RANGE(write number and check direction): R 63W F� East F_V� West <br /> QUARTER SECTION(check one): F1 NE F-1— NW Fy-9 SE F-1 SW <br /> QUARTER/QUARTER SECTION(check one): _ El NE D NW E� SE F-1/1 SW <br /> Jk <br /> 1313 Sherman Street, Room 215, Denver, CO 80203 P 303.866.3567 F 303.832.8106 http://mining.state.co.us =, <br /> « r <br />