PERMFILE111769

• Permit No: M2004067
• IBM Index Class Name: Permit File
• Doc Date: 11/21/2005
• Doc Name: Exhibit 201-202
• From: City of Black Hawk
• To: DMG
• Media Type: D
• Archive: No

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a acrd Erdribhta:
Two (2) complete, unbound application packages must be submitted. One complete application package consists of a signed applicationform
and the set ofmaps end exhibits referenced below as Exhibits A-S, Addendum 1, and the Geotechnical StabilityF.rdribit Each exhibit widen the
application must be presented es a separate section )3egia each exhibit on anew page. Pages should>x numhxred consecutively fox ease of
r+efereace. If separate docrnnents are used as appendices, please reference these byname m the ex]ubiL
With each of the two (2) signed application forms, you must submit a corresponding set of the maps and exhibits as described in the following
references to Rule 6.4, 6.5, and 1.6.2(1 xb):
EXHIBIT A
EXHIBIT 13
EXHIBIT C
F.3~IIBIT D
Ii7~IIBfI'E
F_XHIDIT F
E3Cli18TT O
F.XHTBIT H
ExI~IT I
]?}C1:~TT J
B3CFIIBIT K
EXI~IT L
• EXHIBIT M
EXHIBIT N
EXHIBIT 0
EJ~~IT P
13XIIIBTT Q
F.XFIIBIT R
EXIIIBff S
Rule 1.6.2(I)(b)
Rule 6.5
Legs] Description
Index Map
Pre-Mining aMi Mining Plan Map{s) of AQiected Lands
Mining Plen
Reclamation Plea
ReciamationPlan Map
water Information
Wildl~'e Information
Soils Information
Vegetation Information
Climate Information
Reclamation Costs
Other Permits and Licenses
Source of I,egai Right-To-Enter
Owners of Record of Affected Laud (Surface Area) end Owners of Substance to be Mined
Municipalities Within Two Miles
Proof of Mailing of t`Totices to County Commissioners end Cansavation District
Proof of Filing with County Clerk or Recorder
Permanent Man-Made Structures
ADDENDI7M 1 -Notice Requirements (sample enclosed)
Geoteclmicel Stability Exhibit (any requn-ed sections)
The insovctions for preparing Exhibits A-S, Addendum 1, sad Geotechnical Stability Exhibit are specified under Rule 6.4 e~ 6.5 and
Rule 1.6.2(Ixb) of the Rules and Regulations. If you ]rave any questions on preparing the Exhibits m content of the information required, or
would like to schedule apre-application meeting you may contact the Office at 303-866-3567.
Reauonsbilities as a Permittee:
Upon application approve! and permit issuance, this application becomes a tegaliy binding document. Therefore, there are a
number of important requirements which you, as a permittee, should fully understand. These regtrirt~ents are listed below.
Please read and initial each requireat~t, in the space provided, to acmowledgc that you understand yourobligatrons. lfyou do not
understand these obligations then please contact this Office for a full explanation.
1. Your obligation to reclaim the site is not limited to the amourrt of the financial warranty. You assume legal
liability for all reasonable expenses which the $oard or the Office may incur to reclaim the affected lands associated
with your nursing operation in the event your permit is revoked and financial warranty is forfeited;