Laserfiche WebLink
Division o!'a,eclamatio n, <br /> Jdimng ap.d Sa-Eety <br /> 0 e i iver, C 0'1 9M 3 <br /> LIMITED IMPACT OPERATION(110(1)) <br /> RECLAMATION PERMIT <br /> APPLICATION FORM <br /> CHECK ONE: _a New Application <br /> Permit#M- - (provide for conversions and amendments of existing permits) <br /> The application for a Limited Impact 11 0(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 6.1, <br /> 6.2,-63—,and 6.5,-and(3)the application fee. When you submit your application-be-sure to include one(1) signed and notarized original- <br /> 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 <br /> 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 <br /> I I"or 8 1/2"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 /> 1. Applicant/overatoror company name(name to be used on the permit): Jacob Ulrich <br /> 1.1 Type of organization(corporation,partnership, etc.): Individual <br /> 2. Operation name(pit,mine or site name): Ulrich - Rovedo Mine <br /> 3. Permitted acreage(new or existing): (must be 5 acres or less) 4.99 — permitted acres <br /> 4. Fees: <br /> 4.1 New Application $288.00 application fee <br /> 5. Primary commoditie(s)to be mined: collectable minerals associated with Quartz bearing pegmities <br /> 6. Name of owner to the surface of affected land: USDA- National Forest <br /> 7. Name of owner to the subsurface rights of affected land: Jacob Ulrich and Brent Rovedo <br /> 8. Type of mining operation: Fv] Surface FlUnderground FPlacer <br /> 1313 Sherman Street,Room 215, Denver, CO 80203 P 303.866.3567 F 303.832.8106 http://mining.state.co.us <br />