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COLOR A DO. RECEIVED <br /> Division of Reclamation, <br /> Mining and Safety SEP 18 2024 <br /> Department of Natural Resources <br /> Colorado Division of Reclamation, <br /> 1313 Sherman Street, Room 215 Mining and Safety <br /> Denver,CO 80203 <br /> LIMITED IMPACT OPERATION(110(i)) <br /> RECLAMATION PERMIT <br /> APPLICATION FORM <br /> CHECK ONE: New Application <br /> Permit#M- 202 4 - 0 3 S (provide for conversions and amendments of existing permits) <br /> The application for a Limited Impact 110(1) 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 /> 6.2,6.3,and 6.5; and(3)the application fee. When you submit your application,be sure to include one(1)signed and notarized original <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. Aimlicant/operator or company name(name to be used on the permit): 6,(a 00 y=. of J'AA C1,64 H,aeJs C50- cc e <br /> 1.1 Type of organization(corporation,partnership,etc.): 4,K,77-ib 6,44,L,'rY C-4"oRgs oo� <br /> 2. Operation name(pit,mine or site name): e°,T <br /> 3. Permitted acreage(new or existing): (must be 5 acres or less) permitted acres <br /> 4. Fees: <br /> 4.1 New Application $288.00 application fee <br /> 5. Primary commodities)to be mined: -rO,K Q 0 <br /> 6. Name of owner to the surface of affected land: 8k u Q DXs o f CA F L4 C'X*OX M,At t A6rr &0., LLC.- <br /> 7. Name of owner to the subsurface rights of affected land: 6 A a boys P CR,f f L- C-,e E k rt,N ,,/4 Ca LLc- <br /> 8. Type of mining operation: Surface Underground JDPlacer <br /> OF.Cps <br /> O i <br /> 1313 Sherman Street, Room 215,Denver,CO 80203 P 303.866.3567 F 303.832.8106 http://mining.state.co.us <br /> *1876�- <br />