2003-04-30_PERMIT FILE - M2003030 ‎(2)‎

• Permit No: M2003030
• IBM Index Class Name: Permit File
• Doc Date: 4/30/2003
• Doc Name: Permit Application
• From: Joseph L. Dorris
• To: DMG
• Media Type: D
• Archive: No

RECEIv~ATE CF COLORADO
DIVISION OF MINERALS AND GEOLOGY .APR 3 U. 2003
Department of Natural Resources
1313 $hetman St., Room 215
Denver, Colorado aozo3 - OiYisian ~f Minerals and Geology
Phone: [phone]
FAX: [phone]
Id11IITED IMPACT OPERATION (110(2))
RECLAMATION PERMTT
/~ APPLICATION FORM
(NECK ONE: V New Application (Kale 1.4) Conversion Application (Ride 1.I1)
Permit # M- Z ~~~ - ~ ~ ~ (provide for conversions of existing permits)
~~
DIVISION O'
MINERAL:
GEOLOGY I
REC LAM ATIOP
MIN7NG•SA FETI
Bill Owens
Governor
Greg E. Walther
Executive Direttor
Michael 6. Long
Division Oirectar
The application for a Limited Impact I~signated Mining Operation Reclamation Permit contains three major parts: (I) the
application form; (2} Exhibits A-J, nay required sections of Exhibit S and Geo[echnical Stability Exhibit, as required by the Office,
and outlined in Rules 6.1, 6.2, 6.3, 6.4.19 and 6.5; and (3) the application fee. When you submit your application, be sure to include
offi (1) si¢ned and notarized original and one (1) copy of the application furor, two (2) copies of Fsclubits A-J, app¢opriate suctions of
6.4.19 Exhibit S and 6.5 (Geotechnical Stability Exhibit), as required, and a check for the application fee descnbed under (4) below.
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
Processing Please provide the i~ormation in the format and order de~rrbed in this form.
GENERAL OPERATION INFORMATION
-Type or print clearly, in the space provided, ao information descnbed below
1. Aoulicant/onerstor or comaanv name [name to be used on the permit}: -~° 5'ej°li ~ ~ a r>•~ ~
1.1 Type of organization (corporation, parlnerslvg, e[c.): S al P ~JYbo/~ P /a f
1.2 LRS.TaxIDNo.: ~!
2. Operation name (nit, mine or site name):
3. Permitted acreaee (new or eristhn¢ site):
4. Fees:
4.1 New Application
4.2 Conversion Fee (from 110d to 110(2), (Rule 1.11.2(2))
3 permitted acres
$875.00 application fee
$875.00 conversion fee
5. Prmrarveommoditie(s)tobemined• ~/Y7D r/~L~~a3Dh~'~^ '~P Y11~{~~t° r>7i//+•/2z/S
6. Name of owner to the surface of affected land: LI S 17e~o f o F f}tl /~ G yI'~~. l~ • S • ~KS ~ ~-/'lh ~.
7. Name of owner to the subsurface ri¢hts of affected land: ~as~Dl, ~ ' De/Yti S
r
8. Tvoe of mining operation: ~~ Suiface Underground .i In-situ