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~IPfITEPLRMITCAFPLIC--A-.TIONAFORtE~AY) III'IIIIIIIIIIIIIII <br />STATT: OF COLORADO ° `~ "" ~°~~ Application for dining <br />(Lined Land Reclamation Board and Reclamation Pernit, <br />Department of Natural Resources P"^R , ~ },ija Pursuant to C.R.S. 197J, <br />1313 Sherman Street, Room 723 34-32-101, et seq. <br />Denver, Colorado 80203 <br />LIISITED I;iPACT OPERATLQNS~musC"distuti6`L`E~'~e~HAtl ten acres (including aI1 <br />roads, stockpile areas and any other surface facilities) over the life of <br />the mine, and must extract LESS THAN 70,000 tons of mineral, overburden <br />or combination [hereof per calendar year. If the affected area is some <br />fraction greater than nine acres, be sure iIOT to round it up to ter. acres <br />in the narratives or elsewhere. <br />SPECIAL (TEN-DAY PROCESSING) operations must disturb LESS THAT! Cen <br />acres (including all roads, stockpile areas and any other surface <br />facilities), any' can ONLY be obtained where a federal, state, county, <br />city, town, or special district contract calls for work to be <br />commenced within a SPECIFICALLY SHORT TL`tE. <br />TYPE OR PRINT CLEARLY <br />1. Flame of operations <br />(Pit, mine, or site name) <br />2. Name of applicant/operator <br /> (:Jame to be used on permit) <br />3. Address and phone number of ~ <br />Local offices i_, _ <br />4. Address and phone number $At4E AS N3 ABOVE <br /> of general offices <br />5. Name and phone number of person ~ <br />staff members should contact ,_ __ <br />b. Owner(s) of record of affected ~ <br /> <br />~ <br />land (surface area} <br /> <br />- - -- - <br /> (If more than 2, list below) <br />7. Owner(s) of substance to be mined $AI4E AS N6 ABOVE <br /> (I° more roan 2, list below) <br />l <br /> <br />8. <br />Source of legal right to enter - <br />NOTARIZED LETTER <br /> (Indicate what type of proof is <br />included in Exhibit G -lease, deed, <br /> <br />notarized letter, etc.) _ <br />9. Type of mine 6 substance to be mined OPEN PIT - ROAD BASE MATERIAL <br /> (Specify underground, strip, open pit, <br /> etc. and substance(s) to be mined) <br />0 General location b elevation (Miles APPROXIMATELY MILES <br />OF <br />. b direction from nearest town b _ <br />ELEVATION FEET <br />- <br /> approximate site elevation) <br />.1. County I ~ <br />2. Acreage of affected lands • 5 ACRES OR LESS <br /> (Total surface acreage to be <br />included in permit) <br />~ <br />.J. Application fee (Sec applicable Rule 850.00 ~J ,l <br /> to determine amount} <br />f <br />