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~~ OF COCO~90 <br />r, <br />it r.,~ ~•O <br />~ r876 '~ <br />Richartl D. Lamm <br />Governor <br />RE <br />iii i~iiiii~~iiii~~i • <br />DEPARTMENT OF NATURAL RESOURCES <br />Davitl H Getches, Executive Director <br />MINED LAND RECLAMATION DIi <br />DAVID C. SHELTON, Director <br />~~ <br />1 `~ <br />REGULAR (112) PERMIT <br />APPLICATION FORM <br />..'.D LF1'.. <br />Application for Mining and Reclamation Permit, Pursuant to C.R.S. 1973 ,34-32-101, <br />et ~, as amended. c~ a%~ <br />(Type of Print Clearly) <br /> Miller-Berends Pit <br />1. Name of Operation <br />(pit, mine or site name) <br />2. Name of Applicant/Operator Robert D. "filler and Leslie E. Be.rerds <br /> (name to be used on permit) I d/b/a biller-Berends Pit <br />3. Address and Phone Number of 1971 Counter Road 150 646-4594 <br /> Local Office I Elizabeth, Colorado 80107 <br />4. Address and Phone Number of 1971 County Road 150 546-d594 <br /> General Office I Elizabeth, Colorado 80107 <br />5. Name and Phone Number of Person Robert D. ~?filler 646-4331 <br /> Staff Members Should Contact I Leslie E. Berends 546-4:594 <br />Ha rtil rl ^- Hn rct FdF-"td5~ c•rver <br />6. Parent Corporation, If Any tdone <br /> (include name and address) ~ <br />7. Owner(s) of Record Of Affected N',vrl Ardrev and Thelma Ardrey <br /> Land (surface area) <br /> (if more than two, list in <br /> EXHIBIT P) <br />8. Owner(s) of Substance to be P7vr1 Ardre_v and Thelma Ardrey <br /> Mined (if more than two, list <br /> in EXHIBIT P) <br />423 Centennial Building, 1313 Sherman Street Denver, Colorado 80203 Tel. (30'x) 866.3567 <br />