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1 <br />LIMITED IMPACT OPERATION (110(2)) ~~ ~ 1 ~ 18~® <br />' APPLICATION FORtA MINED LANp <br />RECLAMATION 17tVJS10P1 , <br />The Application fora Limited Impact Operation Reclamation Permit contains three mayor <br />' parts: (1) the Application Form, (2) the Application Exhibits A-F, and (3) the <br />application fee. When you submit your Application, be sure to include two signed copies <br />of the Application Form, two copies of Exhibits A-F, and a check for the app i-T capon fee <br />described under (4) below. To expedite processing, please provide the information in <br />the format and order described in this form. <br />' GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, all information described below. <br />' 1. Applicant/Operator Name: The Denver Brick Com an <br />2. Operation Name (Pit, mine or site name): Merritt Clay Pit <br />' 3. Application type: Limited Impact Operation (110). <br />1 4. Application Fee for Permitted Acreage* 9.99 permitted acres. <br />(b10 x (affected acres) + b25.00).* <br />Note permitted acreage and application fee and <br />attach a check for this amount when you file. $125.00 application fee. <br />1 5. Substance(s) to be mined (e.g., gold/silver/gravel): - Clav <br />t 6. Owners (s) of Substance to be Mined <br />(check applicable box (s )): X Private State Federal Indian <br />7. Owner(s) of Record of Affected Land <br />' <br />(check applicable box (s )): - <br />X Private - - - <br />State Federal Indian <br />8. Type of Mining Operation ~ <br />' <br />(check applicable box (s )): - <br />X Surface - <br />- <br />Underground In-situ <br />9. Location Information. The center o f the area where the majority of mining will <br />' occur lies in: <br /> COUNTY: Jefferson <br /> PRINCIPLE MERIDIAN c ec one XX 6th (Colo rado) 10th (New Mexico) Ute <br />' TOWNSHIP (write number and che ck direction): North X South <br />T 3 <br /> RAIJGE (write number and check direction): _ <br />East X West <br />R 70 <br />' SECTION (write number): <br />QUARTER SECTION (check one): _ <br />S 17 <br />X Nom- NW SE SW <br /> <br />QUARTER/QUARTER SECTION (check <br />one): - - - <br />X NE NW SE SlJ <br /> GENERAL DESCRIPTION: <br />' (miles and direction Approximately 2 miles north of Golden. <br /> from nearest town and <br /> approximate elevation) Approximately 6,200 ft. elevation <br />' * If the operator is a unit of State or county governme nt, an application fee is not <br />required. A fraction of an acre must be counted as one acre for fee calculation. <br />1 <br />