PERMFILE101184

• Permit No: M1995023
• IBM Index Class Name: Permit File
• Doc Date: 4/4/1995
• Doc Name: LIMITED IMPACT OPERATION 110 RECLAMATION PERMIT APPLICATION FORM
• Media Type: D
• Archive: No

• -2
PERMITTING CONTACT (if different from applicant/operator abOVe)
Individual's Name: - Title:
Company Name
Street:
City:
State: Zip Code:
Area Code: Telephone:
INSPECTION CONTACT
Individual's Name:
Company Name
Street:
City:
State: Zip Code:
Area Code: Telephone:
CC: STATB OR FEDERAL LANDOWNBR (if anv)
Agency: Co, $oard of Land Commissioners
Street: Centennial BuildinK 1313 Sherman St, P.oom620
City: nenver
State: CO Zip Coda: 80203-2283
Area Coda: 303 Telephone: R66 3454
CC: STATE OR FEDERAL LANDOWNER (if anv)
Agency:
Street:
City:
State: Zip Code:
Area Code: Telephone:
11. Primary future (Poet-mining) land use (check one):
CC=opLand(CR) Paetureland(PL) _ General A4riculture(GA)
x Rangeland (RL) _ Forestry (FR) _ Wildlife Habitat{WL)
Residential(RS) _ Recreation(RC) Industrial/Cammercial(IC)
_ Developed Water Reeourcee(WR) _ Solid Waste Diepoeal(WD)
12. Primary present land use (check one):
Cropland(CR) Paetureland(PL) _ General Agriculture(GA)
x Ranyeland(RL) _ ForeetrX(FR) _ Wildlife Habitat(WL)
Reeidential(RS) _ Recreation(RC) Industrial/COSOmercial(IC)
_ Developed Water Resourcee(WR) Mining(MN)
13. If this operation will use designated chemicals, or will result, or presently has
acid mine drainage - you cannot use this application form. You must submit a either
a 110d or 112d application form for Designated Mining Operations. In either case,
you must list any acidic or toxic-forming materials, exposed or disturbed as a
result of the mining operation, and whether the operation will result in or
presently has acid mine drainage:
Description of Conversion:
If you are converting an existing operation, provide a brief narrative describing the
proposed change(s).
Maps 6 Exhi„~i ts:
Submit two (2) complete, unbound copies of the following application exhibits:
6.3.1 BXHIBIT A - Legal Description and Location Map
6.3.2 87DiIBIT 8 - Site Description
6.3.3 S7atIBIT C - Mining Plan
6.3.4 H)DiIHIT D - Reclamation Plan
6.3.5 BXHIBIT S - Mape
6.3.6 87ffiIBIT F - Liet of Other Permits and Licensee Required