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__ , <br /> <br />LIMITF~ MPA ~jQ),~ <br />SPECIAL Fpm Y FL ~P <br />APPLICATION FORM <br />n <br />(Type or Print Clearly) <br />State of Colorado ~~ ti 1 ~5II2 Application for Mining and <br />Department of Natural Resou.cces Reclamation Permit, pursuant <br />MINED LAND RECLAffATION BOARD AND DzzVZz$j~ON, <br />'I .,- r, <br />.,i (~ -.,~ C r- <br />~ ~ ~' to 34-32-101, CRS 1973, <br />1313 Sherman Street, Room 423 N <br />P'L_ i_r_ <br />' . <br />. <br />_ as amended <br />Denver, CO 80203 (303) 866•-3567 COIL De' °~ `--'`'_ =~~ ~~~''~~~~'~~~~'~~`•~ <br /> S Z-c1 `~ <br />The following explanations cover Limited Impact applications (110's) and Special (Ten- <br />Day Processing - 111's) applications. In the interest of efficient processing, <br />please check the appropriate box to indicate which tope of application you are applying <br />for here. 111 permits may be issued only under special circumstances. Be sure you <br />are eligible. <br />LIMITED IMPACT OPERATIONS must disturb less than ten acres (including all roads, <br />stockpile areas and aner other surface facilities) over the Life of the mine, and <br />must extract LESS THAN 70,000 tons of mineral, overburden or combination thereof <br />per calendar year. If the affected area is some fraction greater than nine acres, <br />be sure NOT to round this figure up to ten acres in the narratives or elsewhere. <br />^ SPECIAL (ten-day procee~sing) operations are any sand, gravel, or quarry aggregates <br />operations which are to be operated for the sole purpose of obtaining materials <br />for highway, road, utility, or similar-type construction under a Federal, State, <br />county, city, town, or special district contract where the contract calls For work <br />to be commenced within a specifically short time and which will affect ten acres <br />or Zess (including all roads, stockpile areas, and any other surface facilities). <br />INSTRUCTION: This application and all accompanying materials as outlined below must <br />be submitted in duplicate. For further guidance and information for <br />Limited Impact Operations, see RULE 3 and for Special Permits, see RULE 4 <br />1. Name of operation <br />(Pit, mine or site namel <br />Kit Carson County Dist. 2 Road 'Fork <br />2. Name of applicant/operator <br />(Name to be used on permit) <br />• ~IIII~I~~I~~II~~II~ <br />sss <br />t Foreman <br />st 2 <br />3. Address and phone number of Ki Carson County Dist 2 <br />local offices }? Tlebraska ~.ve., Stratton, CO. 80836 <br />_( 3)__348-5282 <br />4. Address and phone nvmbe:^ of K t Cdr n County <br />general offices p, Bo 248, Burlington, CO. 80807 <br />( Z 31 A G_R ~'~R <br />5. Narrre and phone number o.` person <br />staff members should contact <br />