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f <br /> ' . , COLORADO RECEIVED <br /> ® Division of Reclamatior.. <br /> Mining and Safe-",- DEC 0 4 2020 <br /> 1313 Sherman Street.Room 215 <br /> Denver.Cotorado 80203 DMSION OF RECLAMATION <br /> MINING AND SAFETY <br /> CONSTRUCTION MATERIALS <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 6.1,62,63,6.5,and 1.6.2(1)(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,sinned 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 %'X i 1"or 8%'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 /> r <br /> 1.1 Type of organization(corporation,partnership,etc.): Co✓ bn <br /> 2. Operation name(pit,mine or site name): Rkrge t ;r(P2 Jo�rs�� <br /> 3. Permitted acreage:(must be 30 acres or less) —00 Permitted Acres <br /> 4. Fees: <br /> 4.1 New Application $400.00 Application Fee <br /> 5. Primary commoditie(s)to be mined: IE i Low j <br /> 6. Name of owner to the surface of affected land: 4411C <br /> 7. Name of owner to the subsurface rights of affected land: Fr11C <br /> 8. Location information: The center of the area where the majority of mining will occur: <br /> COUNTY: FJ P=l <br /> PRINCIPAL MERIDIAN(check one): J I 6th(Colorado) n 1 Oth(New Mexico) 0 Ute <br /> SECTION(write number): S 8 <br /> TOWNSHIP(write number and check direction): T 115 H <br /> North South <br /> RANGE(write number and check direction): R East X West <br /> QUARTER SECTION(check one): NE _ NW _�� SE _Q SW <br /> QUARTER/QUARTER SECTION(check one): F NE NW F _ SE M_SW <br /> 1313 Sherman Street. Room 215,Denver,CO 80203 P 303.866.3567 F 303.832.8106 http://mining.state.co.us ? <br />