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iii iiiiiiiuiiiiiii ® / <br />999 ~~~~~~~ <br />of ~~~o <br />Q~ ~" OCT 2 G 1981 <br />r, 'l~`o~~ gi DEPARTMENT OF NATURAL RESOURCES <br />y ~ ~ ~ David H. Getches, Executive Director M1NEp LAND ~ <br />';,~ MINED LAND RECLAMATIOp~a.IlVpi31~V'(~(s)o <br />DAVID C. SM ELTON, Director <br />Richartl D. Lamm <br />Governor Application Form fora Permit <br />to - <br />Conduct Coal Mining in Colorado <br />Application to conduct surface or underground coal mining activities or other <br />surface coal mining and reclamation operations in Colorado pursuant to CRS, <br />34-33-101, et seq. <br />For an application to be deemed complete by the Division pursuant to CRS, <br />34-33-103(5) and Rule 1.04(30), an applicant must: (1)~supply all information <br />as specified on this application form; (2) submit five reproducible copies of <br />the permit application with original signatures; and (3) pay the appropriate <br />fee required by Rule 2.01.6, <br />Please note that this form is only a listing of <br />and does not constitute a checklist of detailed <br />requirements. A finding of completeness should <br />adequacy of an application. Additional informs <br />may be required for adequacy depending upon the <br />application. <br />general category requirements <br />permit application <br />not be interpreted to imply <br />ti on not listed on this form <br />individual circumstances of an <br />This form consists of two major parts: (1) a section entitled General <br />ration Information and (2) a section entitled'Ap lication Requirements. <br />Specs is instructions for filling in the necessary to ormatron or eac <br />section appears immediately below the title of each section. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly the appropriate information as listed below. <br />Supplemental sheets may be used as necessary, such sheets must be attached to <br />the form and referenced or keyed to the numbers on the form, <br />1. Application Number (to be filled in by the Division): C g ~ -~ ~ ~ <br />2. Permittee ~~~~_~~~~~_~~~~ <br />3. Mine or Site Name: 8i~~-~~~~~_~a.~.~_-- <br />4. Current Permit Type: C 0 <br />5. Application Submitta] Date ~ ~/11/~ ...fi <br />6. Application Fee: E~ 2 ~,_0_ Q Incremental Fee Schedule: <br />7, Commodity Mined: C 0 A <br />423 Centennial Building, 1313 Sherman Street Denver, Colorado 80203 Tel. (303) 866-3567 <br />