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DEPARTMENT OF NATURAL RESOURCES <br />OWid H. Ci~ICA„. Ei+CUnvtr Dlnctor <br />MINED LAND RECLAMATION DI\ <br />DAVID G. SMEITON, Dlnctor <br />Ricnrrd D. Lamm <br />Gowmor <br />Application Form for a Permit <br />to <br />Conduct Coal Mining in Colorado <br />Application to conduct surface or underground coal mining activities or other <br />surface coal mining and reclamation operations 1n Colorado pursuant to CRS, <br />34-33-101, et ~. <br />For an application to be deemed complete by the Division pursuant to CRS, <br />34-33-103(5) and Rule 1.04(30), an applicant must: (1) supply all information <br />as specified on this application form; (2) submit flue reproducible copies of <br />the permit application with original signatures; and (3) pay the appropriate <br />fee required by Rule 2.01.6. <br />Please note that this form is only a listing of general category requirements <br />and does not constitute a checklist of detailed permit application <br />requirements. A finding of completeness should not be Interpreted to Imply <br />adequacy of an application, Additional information not listed on this form <br />may be required for adequacy dependlna upon the Individual circumstances of an <br />application. <br />This form consists of two mayor parts: (1) a section entitled Generai <br />0 eration Information end (2) a section entitled A lication Re uTments. <br />pec c ns ruc ons for filling in the necessary n ormat on or eac <br />section appears immediately below the title of each section. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly the appropriate information as listed below. <br />Supplemental sheets may be used as necessary. such sheets must be attached to <br />the form and referenced or keyed to the numbers on the fo-m. <br />1, Application Number (to be filled in by the Division): C-8 4 -~ ~ ~ <br />2. Pennsttee ~.~~~..~1~3-...G~~L_L.o_m.~.a_~.~. <br />3. Mine or Site Name: E a s t ~ 1 d ~ - ~ ~,~ ~ - - - - - <br />4. Current Permit Type: C 0 - <br />5. Application Submittal Date 0 2/ 2 4/ 8 4 <br />6. Application Fee: i_- I, 3 5 5 Incn~mental Fee Schedule: - <br />1. Commodity Mined: C 0 A <br />423 Centennial Building, 1313 Sherman Street Denver, Colorado 80203 Tel. (303) 866-3567 <br />