REV95678

• Permit No: M1977302
• IBM Index Class Name: Revision
• Doc Name: REGULAR 112 PERMIT APPLICATION FORM
• Type & Sequence: AM2
• Media Type: D
• Archive: No

• . iii iiuiiiiiimiii

REGULAR (112) PERMIT
APPLICATION FORM
This form contains two major parts: (1) General Operation Information and (2) Exhibits
A-P. When you submit your application, be sure to include four signed copies of the
General Operation Information, four copies of Exhibits A-P, and a c e k for the
application fee described under (4) below. To expedite processing, please provide the
information in the format and order described in this form.
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GENERAL OPERATION INFORMATION
Type or print clearly, in the space provided, all information described below.
1. Applicant/Operator Name: Colorado Lien comnanv
2. Operation Name (Pit, mine or site name}: owl Canyon
3. Application type: Regular (112) Permit Operation.
4. Application Fee for Permitted Acreage* ~_r,R p~annitted
acres.
(E50.00 + 515.00/acre, 1st. 50 acres;
510.00/acre, 2nd. 50 acres; 55.00/acre, 3rd. 50 acres;
51.00/acre, any additional acreage; maximum fee of
52,000.00).*
Note permitted acreage and application fee and
attach a check for this amount when you file: gloo.oo ap~~lication fee.
5. Substance(s) to be mined (e. g:, gold/silver/gravel): storage Area
6. Owners(s) of Substance to be Mined
(check applicable box(s)): x Private State Federal Indian
7. Owner(s) of Record of Affected Land
(check applicable box(s)): x Private State Federal Indian
8. Type of Mining Operation
(check applicable box(s)): ~ Surface _ Underground _ [n-situ
9. Location Information. The center of the area where the ca.jority of mining will
occur lies in:
COUNTY: Larimer
PRINCIPLE c ec one 6th (Colorado) 10th (New Piexico) Ute
TOWNSHIP (write number and check direction): T lp x Nortlr South
RANGE (write number and check direction): R 7p _ East ~ West
SECTION (write number): S ~
QUARTER SECTION (check one): ~ NW SE ~ SW
QUARTER/QUARTER SECTION (check one): _ NE _ NW = SE ~ SW
GENERAL DESCRIPTION:
(miles and direction 2~ Hiles ri.w. of Ft. Collins
from nearest town and
approximate elevation) 6,no0 Feet
* If the operator is a unit of State or county government, an application 'Fee is not
required. A fraction of an acre must be counted as one acre for fee calcul,ition.