PERMFILE104446

• Permit No: M1999029
• IBM Index Class Name: Permit File
• Doc Name: CONSTRUCTION MATERIALS LIMITED IMPACT 110 OPERATION RECLAMATION PERMIT APPLICATION FORM
• Media Type: D
• Archive: No

SLB 10 STATE OF COLORADO
Rev. 03/90 STATE BOARD OF LAND COMMISSIONERS
Department of Natural Resources
1313 Sherman Street, Roan 620
Denver, CO 80203
Phone [phone]
APPLICATION FOR SAND, GRAVEL AND STRUCTURAL FILL PERMIT
(State and/or Local Governments Only)
Date ~~~~~
To the State Board of Land Commissioners
I hereby apply for a Nining Permit on the following described land(s):
ACRES SUBDIVISION SECTION TOWNSHIP RANGE COUNTY
I wish to hold this permit for ~ years.
Answer the following questions, furnish a sketch moo of section and location of mineral deposit, Sian and return
this form together with the 550.00 per year filing fee. Questions below must be answered, or an explanation
given, before the Board will give its consideration to this application. False statements will work forfeiture
of applicant's rights.
1. Nhat specific material type do you wish to mine? (~ /Q ~/ -
OY. dn0 c
2. Is this permit for a short-term project or for long-term maintenance? L d h G ! 2 Y
Explain. LOGO.
Ol~er
Lar.rl h COwh,'fJ w, !1r'_~if'rac
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3. To your knowledge,
yr? S If so, e~wr-~-i.Qe,f~ethe ~;~
have these described lands been mined
describe. ~~'~ S n b~~o.•-y %~v't e QTc~urt pc"'~ P
for sand, gravel or structural fill in the ast.
b./ ~'he <a~G e ho/e i~tJ~'Gr,P ~eJ~~
4. Do ygu know of any person other than yourself, who claims any right to the materials on any portion of the
above described lands. ~ If so, give name and address of such person.
5. Da you know of any ersan at the date of your application who has ever engaged in exploration work on these
described lands? ~ If so, give name and address of such person. /(!• v~ ~itJQ~ t O
~/w ri a) (r n~a .~ ]~./ ~'~l,L-F"C~ 1.0. wCJ ~f12/-rd CD/'Y[ p~f~2 C~Co rf>'
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After completing this application, please read it carefully before signing.
Name of State or Local Government Unit:
APPLICATION FEE
years X ;50.00 =Q•
THE FEE FOR THE ENTIRE LENGTH
OF THE PERMIT IS GJE WHEN
THE PERMIT IS ISSUED.
FOR OFFICE USE ONLY
Patent
Fund

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(Please Print or Type)
Name of Responsible Person:
Kew S-f
~~~ (Please Prin ~ Ty 1 t n
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Signature:
Address: ~i ~S-~'J~n r r. ~fYe
wr L.~S P ,r /
C. Zip(y~/
Phone: ~~~ S'o~-~ -" ~c~fs'r4