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A71COiL ( <br /> Mini ng a ERR/jdm ����,��D <br /> I Department <br /> JAN 0 9 29ZA <br /> 1313 Sherman Street, Room 215 <br /> Denver, CO 80203 <br /> DIVISION OF R�CIAMAT10N <br /> MINING&SAFETY <br /> LIMITED IMPACT OPERATION(110(1)) <br /> RECLAMATION PERMIT /� �yJS lGd <br /> APPLICATION FORMow <br /> / <br /> CHECKONE: New Application <br /> Permit#N4,2019 _055 (provide for conversions and amendments of existing permits) <br /> The application for a Limited Impact II0(1) Mining Operation Reclamation Permit contains three major parts: (1)the application form; <br /> (2)ExhibitsA-J,any required sections of Exhibit S and Geotechnical Stability Exhibit,as required by the Office,and outlined in Rules 6.1, <br /> 6.2,6.3,and 6.5;and(3)the application fee. When you submit your application,be sure to include one(1)sign2d 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 /> 11"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/operator or company name(name to be used on the permit): lames and Yvette Downing <br /> 1.1 Type of organization(corporation,partnership,etc.): <br /> 2. Operation name(pit,mine or site name): D Family Jewels <br /> 3. Permitted acreage(new or existing):(must be 5 acres or less) 1 permitted acres <br /> 4. Fees: <br /> 4.1 New Application $288.00 application fee <br /> 5. Primary commodities)to be mined: Gems,Amzonite,Silver and Gold <br /> 6. Name of owner to the surface of affected land: A1l�10nat i'Ur e S 4- (US.PS) <br /> 7. Name of owner to the subsurface rights of affected land: 1 CL w S 0-nd VV e+� - uC lti n <br /> 8. Type of mining operation: a Surface 21 Underground IIPlacer / <br /> 1313 Sherman Street, Room 215, Denver,CO 80203 P 303.866.3567 F 303.832.8106 http://mining.state.co.us <br />