2019-10-24_PERMIT FILE - M2019038

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COLORADO Division of Reclamation, Mining and Safety RECEIVED Department of Natural Resources 1313 Sherman Street,Room 215 OCT 2 4 2019 Denver,CO 80203 LIMITED IMPACT OPERATION(110(1)) DIVISION OF RECLAMATION, RECLAMATION PERMIT MINING&SAFETY-MINERALS , APPLICATION FORM CHECK ONE: g New Application Permit#M-ajQfi- O 3 V (provide for conversions and amendments of existing permits) The application for a Limited Impact 110(1) Mining Operation Reclamation Permit contains three major parts: (1)the application form; (2)Exhibits A-J,any required sections of Exhibit S and Geotechnical Stability Exhibit,as required by the Office,and outlined in Rules 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 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 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 1/2"X 11"or 8 1/2"X 14"size. To expedite processing,please provide the information in the format and order described in this form. GENERAL OPERATION INFORMATION Type or print clearly,in the space provided,all information described below 1. Applicant/operator or company name(name to be used on the permit): C�- 1.1 Type of organization(corporation,partnership,etc.): L L 2. Operation name(pit,mine or site name): 3. Permitted acreage(new or existing): (must be 5 acres or less) +,Q "1 i permitted acres 4. Fees: 4.1 New Application nn $288.00 application fee 5. Primary commoditie(s)to be mined: �7 °�r/ t—P C C�4 <; 4f �s 6. Name of owner to the surface of affected land: L rn 7. Name of owner to the subsurface rights of affected land: C (3 R G- 8. Type of mining operation: 0 Surface Li Underground OPlacer C 1313 Sherman Street, Room 215,Denver,CO 80203 P 303.866.3567 F 303.832.8106 http://mining.state.co.us rµIR76 rw