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TATE OF COLORADO <br />r <br />DIVISION OF MINERALS AND GEOLOGY <br />Department of Natural Resources <br />7 313 Sherman St., Room 215 C O L D RA D O <br />Denver, Colorado 80203 D I V t 5 I O N o r <br />Phone: (303) 866-3567 MINERAL S <br />FAX: (303) 832-8106 G E O L O G Y <br />LIMITED IMPACT OPERATION 110 2 0.ECLAN ArION•NINING <br />( ( N SAFETT•sCIENCE <br />RECLAMATION PERMIT <br />Bill Owens <br />[pA,} - /l r APP/L'ICtA11TIO[N FORM eovemor <br />~~II /?ItARti,~H„p,~- 't'Dr lSelO~ 6a-'Slv~ ~ex,~.li-~ CinO 'pie ~~ Ezetutive Director <br />~ I.N t Ronald W. Catlany <br />(`HRr`x nNF: New Application (Rule 1.4) Conversion Application (Rule 1.11) l/~r~)-/~~~~ Division Director <br />'~ "'~ Natural Resource Tmstee <br />Permit # M- (provide for corrversions of existing permits) <br />The application for a Limited Impact Designated Mining Operation Reclamation Permit contains Uuee major parts: (1) the <br />appligtion form; (2) Exbibits A-J, any required sections of Exhibit S and Geotechnical Stability Exlubit, as required by the Office, <br />and outlined in Rules 6.1, 6.2, 6.3, 6.4.19 and 6.5; and (3) the appligtion fee. When you submit your application, be sure to include <br />one (1) a~oneA And nntari~e±l 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 [he 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 clearly, in the space provided, all information described below <br />1. App irant/nnerafnr nr company name (name to he need nn the rmiFle <br />L1 <br />1.2 <br />Type of organization (corporation, partnership, etc.): <br />I.RS. Tax ID No.: <br />2. ()nerAtinn name (Rij mine nr site nAmel~ <br />3. PermiMerl ArreAVe (new nr esiating titel• <br />4. Eeels: <br />4.1 New Application <br />4.2 Conversion Fee (from 1104 to 110(2), (Rule 1.11.2(2)) <br />5. Pnmanr rnmmnditielyl to IEe mined <br />6. NAme rLf owner to the wrrfare n( Affected IAnd- <br />7, NAme of n er to the nEhsEErfare rigbta rd' AHerted IAnd' <br />$. Tine ELf mining nTEeratinn~ $urfaee Undergronnd <br />In-situ <br />permitted acres <br />SR75 ()0 application fee <br />SR7S 110 conversion fee <br />ate of <br />Mined Land RErlamation <br />Office of <br />Active and Inactive Mines <br />Colorado <br />Geological Survey <br />