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<br />DIVISION OF MINERALS AND GEOLOGY „ <br />Department of Natural Resources v <br />1313 Sherman St., Room 215 <br />Denver, Colorado 80203 <br />Phone: (30318663567 <br />FAX: (303) 832-8106 <br />~-~OD ~ -03 ~ - <br />STATE OF COLORI~DO <br />RECE89~ED <br />~~ l~(~ ~ s 2~(J6 <br />~~ COLORADO <br />DIVISION O F <br />MINERALS <br />GEOLOGY <br />0.ECLAM ATION•NINING <br />SAf ETY•ECIEN CE <br />LIMITED IMPACT OPERATIUI~ 41~aerala and Gealopy <br />RECLAMATION PERMIT 1 / <br />APPLICATION FORM 1M <br />t'uF~x nuF; / New Application (Rule 1.4) Conversion Application (Rule 1.11) <br />Permit # M- - (provide for conversions of existing permits) <br />Bill Owens <br />Governor <br />Russell George <br />Executive Director <br />Ronald W. Cottony <br />Division Director <br />Natural Resource trustee <br />The application for a Limited Impact Designated Mining Operation Reclamation Permit contaias three major parts: (1) the <br />application form; (2) Exhibits A-J, any requited sections of Exhibit S and Geotechnical Stability Exhibit, as required by the Office, <br />and outlined in Rules 6. i, 6.2, 6.3, 6.4.19 and 6.5; and (3) the application fee. When you submit yow application, be sure to include <br />one (1) s~vnevi and nnrari>rl original and one (1) copy of the application form, two (2) copies of Exhibits A-J, appropriate sections of <br />6.4.19 Exhibit S and 6.5 (Geotechnical Stability Exhibit), as required, and a check for the appliption fee described under (4) below. <br />Exhibits should not be bound or in a 3-ring binder; maps should be folded to 8 1/2" X 11" or 8 1/2" X 14" size. To expedite <br />processing, please provide the information in the format and order described in this form. <br />GENERAL OPERATION INFORMATION <br />Type or print dearly, in the space provided, all information described below <br />1. Applirantlpppratnr nr rnm=nanV name foam to he! need nn the-permitl• ~,ti ~o~q[/~ C. ~%r/dh/P/' ~~'/~~r~r- /01C <br />1.1 Type of organization (corporation, partnership, etc.): /'r~.~tt/u ~'~ r/ <br />1.2 I.RS. Tax ID No.: ~'~ - ~ <br />2. nneratinn name (~ mina nr aite namel! LfJI ~~ ~U ~I )sN r° f ~,r~ • ~~~I wn 9i <br />3. Permitted arrea¢~new nr esicfing vital! rJ' 3 ~ permitted aere5 <br />4. Fees: <br />4.1 New Appliption SR75 Gn application fee <br />4.2 Conversion Fee (from 110d to 110(2), (Rule 1.11.2(2)) SR75 ~ conversion fee <br />5. Prima, ~+ rnmm,ulitiefgl to I,e mined! <br />6. Name of owner to th e snrfare of affeeled land! U .5 , `~. o~ /; c U ~ '~ /(° lI. S _ ~ r 5 fi .~O/'/rt~.e- <br /> <br />~]. Name of owner to th e erhsnrfare ri~hta ,d' affected land! CD Io fR [_/O f-t7 ~Ur>'rP ~ CO~ J4rJ -jAC <br /> <br />$, ~pe of minin~nperatinn! '~Sutface <br />Underground '~ Tn-situ <br />Office of Office of Colorado <br />Mined Land Reclamation Active and Inactive Mines GEblogical Survey <br />