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•IP1ITEpERrI'TCAFPLDCATI07AFOR.`tE~AY) III III'llllllllllll <br />STATE OF COLORADO ° `~ ~'~~'~°~~ Application for toning <br />lSined Land Reclamation Board and Reclamation Pexnit, <br />Department of Natural Resources ~ R ~ },lra Pursuant to C.R.S. 1973, <br />1313 Sherman Street, Room 723 h'r' 0 34-32-101, et seq. <br />Denver, Colorado 30203 <br />LIIfITED I:IPACT OPERATLONS~aiusr"distu'rb`L'E~~E~[IAII ten acres (includingz all <br />roads, stockpile areas and any other surface facilities) over the life of <br />the mine, and must extract LESS THA;t 70,000 tons of mineral, overburden <br />or combination thereof per calendar year. If the affected area is some <br />fraction greater than nine acres, be sure NOT to round it up to ter, acres <br />in the narratives oc elsewhere. <br />SPECIAL (TEN-DAY PROCESSING) operations must disturb LESS TNA:~ [en <br />acres (including all roads, stockpile areas and any other surface <br />facilities), anr' can ONLY be obtained where a federal, state, county, <br />city, town, or special district contract calls for work to be <br />commenced within a SPECIFICALLY SHORT TL`SE. <br />TYPE OR PRINT CLEARLY <br />1. P]ame of operations <br />(Pit, mine, or site name) <br />2. :lame of applicant/operator <br /> (game to be used on permit) <br />3. Address and phone number of I <br />local offices __ _ <br />4. Address and phone number $AME AS b3 ABOVE <br /> of general offices <br />5. Name and phone number of person ~ <br />staff members should contact I __ __ <br />' <br />6. Owner(s) of record of affected ~ <br /> <br />~ <br />land (surface area) <br /> <br />- - -- - <br /> (If more than 2, list below) <br />7. Owner(s) of substance to be mined SAME AS N6 ABOVE <br /> (If more [non 2, list below) <br />8. Source of legal right to enter NOTARIZED LETTER <br /> (Indicate what type of proof is <br />included in Exhibit G - lease, deed, <br /> <br />notarized letter, etc.) _ <br />9. Type of mine & substance to be mined OPEN PIT - ROAD BASE MATERIAL <br /> (Specify underground, strip, open pit, <br /> etc. and substance(s) to be mined) <br />0. General location 6 elevation (riiles APPROXIMATELY MILES <br />OF <br /> b direction from nearest town b <br />i <br />i <br />l <br />i _ <br />ELEVATIOIJ FEET <br /> approx <br />mate s <br />te e <br />evat <br />on) <br />1. County I I <br />2. Acreage of affected lands <br />(T <br />f <br />b .5 ACRES OR LESS <br /> otal sur <br />ace acreage to <br />e <br />included in permit) ~ <br /> <br />3. <br />Application fee (See applicable Rule ,{ <br />$50.00 (~~ ,~ <br /> [o determine amount) <br />