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iii iiiiiiiiiiiii iii <br />999 <br />STATE OF <br />RADO <br />~ -~~ --- <br />DIVISION OF MINERALS AND GEOLOGY <br />Depdnmem of \,ilwal Resnurt e. ~/~.~,/Or/ ~ ~ 7 //qq <br />7 11 i Sherman Si .Room ' 13 U/ / 4/~' II~ <br />Dem rr. (uloradu 80'U3 ,~~~oo, ~ <br />PhunP' ~ SI14~ df,h-iin,- Grp <br />r~~ ''°' sn-nl°`' APPLICATION FORM FOR A PERMIT ~ ~'~~~. DEPARTMFNi OF <br />To "v° NATURAL <br />CONDUCT COAL MINING IN COLORADO RESOURCE` <br />Application to conduct surface or underground coal mining activities or other surface coal R°„ Romer <br />mining and reclamation operations in Colorado pursuant to C.R.S. 34-33-101 et seq. Governor <br />lames 5. Lochhead <br />Evecmive Direcmr <br />For an application to be deemed complete by the Division pursuant to C.R.S. h„cnae~9. EOng <br />34-33-10315) and Rule 1.041301, an applicant must: 111 supply all information as Di„i,ion Direcro, <br />specified on this application form; (21 submit five reproducible copies of the permit <br />application with original signatures; and 13) pay the appropriate fee required by Rule 2.01.6. For <br />federal mines, please refer to the Federal Agency Mailing List available from the Division and provide <br />one copy to each of the agencies on that list, at the same time the application is submitted to the <br />Division. Proof of distribution to the federal agencies should accompany the application. Copies <br />of application pages modified during the review process must be distributed in the same manner, <br />along with proof of distribution. <br />Please note that this form is only a listing of general category requirements and does not constitute <br />a checklist of detailed permit application requirements. A finding of completeness should not be <br />interpreted to imply adequacy of an application. Additional information not listed on this form may <br />be required for adequacy depending upon the individual circumstances of an application. After a <br />decision has been reached on this application, the operator must update the permit application on <br />file at DMG and OSM. For non-federal mines, one copy must be sent to OSM in Albuquerque, New <br />Mexico. <br />This form consists of two major parts: 111 a section entitled "Application General Operation <br />Information: and 121 a section entitled "Application Requirements." Specific instructions for filling <br />in the necessary information for each section appears immediately below the title of each <br />section. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly the appropriate information as listed below. Supplemental sheets may be <br />used as necessary; such sheets must be attached to the form and referenced or keyed to the <br />numbers on the form. <br />1. Application Number lto be filled in by the Divisionl: C - 8 1 - 0 1 2_ <br />2. Permittee: P I C K E T W I R E <br />- - - - - - - - - - - - - - - - <br />F F. 0 C t 5 S I N G, L L C <br />- - - - - - - - - - - - - - <br />3. Mine/Site Name: i~ - Lv E L ;< ~ i I N I: <br />4. Current Permit Type: C O <br />