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A DNR ' COLORADO RECEIVED <br /> 4-coDivision of Reclamation, APR 2 8 2025 <br /> 1 Mining and Safety AM-1 <br /> 1 Department of Natural Resources ERR/ZTT <br /> Colorado Division of Reclamation, <br /> 1313 Sherman Street, Room 215 Mining and Saftey <br /> Denver,CO 80203 <br /> LIMITED IMPACT OPERATION(110(1)) <br /> RECLAMATION PERMIT <br /> APPLICATION FORM <br /> 0 Mak.. 4.4 10.awwwAass4,1 ' <br /> CHECK ONE: ❑ New Application <br /> Permit#M-ao..3 - a b1 (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. Applicant/operator or company name(name to be used on the permit): i?st e.,L L, &:a t <br /> 1.1 Type of organization(corporation,partnership,etc.): S a 1.. reap (14 4 or <br /> 2. Operation name(pit,mine or site name): (5...:3 t M%.%' <br /> 3. Permitted acreage(new or existing):(must be 5 acres or less) S permitted acres <br /> 4. Fees: <br /> 4.1 New Application $288.00 application fee <br /> 5. Primary commoditie(s)to be mined: T a,...afi 4-4 ,..►:...e`I S P" t:N+aws,A.+m.a..Aj 4*c Simi tcv erlw.f:,a0,44. 6l...f h <br /> 6. Name of owner to the surface of affected land: L1. S.F. S <br /> 7. Name of owner to the subsurface rights of affected land: 8.L..PA. <br /> 8. Type of mining operation: © Surface ❑ Underground IIPlacer <br /> I <br /> 1313 Sherman Street,Room 215,Denver,CO 80203 P 303.866.3567 F 303.832.8106 http://mining.state.co.us *�.'. ' <br /> '-'�Ig76 ' <br />