PERMFILE57631

• Permit No: M2004053
• IBM Index Class Name: Permit File
• Doc Date: 7/21/2004
• Doc Name: Application
• From: Riveras Excavation
• To: DMG
• Media Type: D
• Archive: No

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COSTILLA COUNTY
PLANNING & ZONING DEPARTMENT
MINING APPLICATION
Application No. ~ 00 t~ - O l ci Docket No.
NOTE: Unless specifically waived by the Costilla County Planning Department, all items in this application
must be completed. (Your application will not be scheduled for a Planning Commission hearing if this
application is not fully completed.)
APPLICANT:~ruF~as ~icca~a~-tan. 30~ ~~ycv-4.
ADDRESS: "t~.0. (3oa 9•f city~m~i~, state~_zip8-tS1
Address of Proposed Development
TELEPHONE: FAX.
Complete LEGAL DESCRII'TION OF THE PROPERTY (attach a copy of deed or survey plat)
PROPERTY OWNER: (If different than applicant, a copy of a contras for sale or lease between
applicant and owner, or a notarized letter from the owner consenting [o this application, must be
submitted.)
Name:
Address:
Telephone: FAX.
AUTHORIZED REPRESENTATIVE:
Name:
Address:
Tele hone: FAX.
COMMON DESCRIPTION OF LOCATION OF PROPERTY: (by address. mileage from highway or
C~j my road, or other recognized landmarksJ~^~ r» r /~_S ~~~~ m ~dl,Pi~so ~~cs .
~L/11 ~1! Rc~ C- J~C~°~
ATTACH ROOF OF OWNERSHIP: attach a co of deed or surve lat
SUBMITTAL REQUIREMENTS: (From the Costilla County Land UseCode)
I. Application Form and Fee (4.5 A-D)
2. Vicinity Map (4.5 - E)
3. Site Plan (4.5 - E (2) )
4. Referral Packets (4.5 - n
"LISTALLLANDOWNERS, LANDOWNERSADDRESSESANDLAND USESWHICHARE
ADJACENT TO THE BOUNDARIES OF THE ENTIRE PIECE OF PROPERTY WHICH IS
PROPOSED TO BEMINED. (including all properties located immediately across any highway or
road. )
F ,ol~U
ACCESS:
Transportation access is provided by:
Ihghway Route Designation
County Road Number(s)
Street, Lane, or Trail Name(s)
Indicate if either of the following is required;
_ Colorado Dept. of Transportation highway access permit
Costilla Count Drivewa access ermit.
continued on page 2 revised 8/99