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. 7/78 ;'
<br />" ~ -~±s LIM1iZ'dl) IMw~CT (110)
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<br />~~ ,_,, ~~,,,,, > >~, APPL I CA710N FORM
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<br />PERMI -1~ ~ sss '~
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<br />State of Colorado .°`~"s~~..- "' ~'_ _ Application for Mining and
<br />,~. -.
<br />Department of Natural Resources ~•':-:,,,,` ,_ s. Reclamation Permit, pursuant
<br />MINED LAND REGLAMATION BOARD '"'' ~ .~[cR5 1.973, 35-32-101, et seq
<br />1313 Sherman Street, Room']21 #'
<br />Denver, CO 80203 (303) 839-3587 MINED LAND R~CLAMATIDN
<br />~. Deot. of N,ural Resources
<br />The following explanations cover Limited Impact applications (110s) and Special (Ten-
<br />Day Processing)(llls) applications. In the interests of efficient processing, please
<br />check the appropriate box to indicate which type of application you are applying for here.
<br />~L1111TE0 IMPACT OPERATIONS must disturb LESS THAN ten acres (including
<br />all roads, stockpile areas and any other surface facilities) over the
<br />life of the mine, and must extract LESS THAN 7D,000 tons of mineral,
<br />overburden or combination thereof per calendar year. If the affected
<br />area is some fraction greater than nine acres, be sure NOT to round this
<br />figure out to ten acres in the narratives or elsewhere.
<br />_~ SPECIAL-(TfiN-DAY PROCESSING) operations must disturb LESS THAN tecr acres
<br />(including all roads, stockpile areas end any other surface facilities),
<br />and can ONLY be obtained where a federal; state, county, city, town or
<br />special district contract calls for work to be commenced within a
<br />SPECIFICALLY SHORT TIME.
<br />F,"le
<br />(V u.
<br />'19- Ion.
<br />(Type or Print Clearly)
<br /> ~lE
<br />1. Name of operation
<br />
<br /> (Pit, mine or site name)
<br />2. Name of applicant/operator
<br /> (Name to be used on permit)
<br />3. Address and phone number of F
<br /> local offices
<br />4. Address and phone number of
<br />
<br /> general offices
<br />_
<br />~= 33s3
<br />5• Name and phone number of person ~~
<br /> staff members should wntact
<br /> L- 33 5 3
<br />6. Owner(s) of record of affected
<br /> land (surface area) (If.mare r '~
<br /> than 2, list below)
<br />7. Owner(s) of substance to be mined 2 ..~ ~
<br /> (If more than 2, list below) ,
<br />8. Source of legal right to enter
<br /> (Indicate what type of proof is
<br /> included in EXNIBIT G - lease,
<br /> deed, notarized letter, etc.)
<br />4• Type of mine 6 substance to be
<br /> mined (Specifyunderground, strip Q ¢_
<br />. -(~pgQ. p.l Yw~etC. J;. ....t,~r.-.,.. ~) t.Q. _._~.. ._._ ._
<br /> be mined)
<br />l0. General location G elevation
<br />
<br /> (Miles & direction from nearest
<br /> town E approximate site eleva-
<br /> t i on)
<br />11. County
<br />12. Acreage of affected lands
<br /> (Total surface acreage to be
<br /> included in ermit
<br />
<br />13•
<br />Rppl ication f~,>(5~se appl ieable ..h...
<br />~e1~'
<br /> RULE to determine amoun
<br />t) `'
<br /> z
<br />
<br />)
<br />.j
<br />S .}~ ~ ~ - {Hues)
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