PERMFILE116522

• Permit No: M1978332
• IBM Index Class Name: Permit File
• Doc Date: 10/6/1981
• Doc Name: LIMITED IMPACT 110 AND SPECIAL TEN DAY 111 PERMIT APPLICATION FORM
• Media Type: D
• Archive: No

~C~P*~I DIO (0R)1)PL~NIT ~ IIIIIIIII9IIIIIIIII
State of Colorado ,application for :7iaiag and
Departsent of 5atural Rasourcas Reclamation Perait, nursuaat
%rreD LAND REC'..aP"~TION BOARD RECEIVE® to CRS 1973, 34-32-101, et seq
1313 Sherman Street, Room 423
Deaver, CO 80203 [phone]
Tha following explanations cover Limited Laoaet analications (110's) and Soecial (Ten-
Day Processiag)(111's) applications(y)IN~ LANOtiifAlrWA~BN~fficient processing, please
che~c the anpropriata box to ladic~{~~ np~p~~ Rgpilbdition you are applying for
hero. I11 Hermits may be isauad only wader special circumstances. Ba sure you era
ellgibla.
LL4fIT°-D Lw34CT OPE4ATIO:IS s~tst disturb L-eSS T&VV ten acres (including all
roads, stockpile areas and any ocher surface facilities) over the Iife o`.
Cho miao,_ and must aatr~t '.w33 IfiA.Y 70,000 tons of mineral, overburden or
combination thereof per calendar near. I: the affected area is seine fraction
greater than nine acrea, be sure NOT to round this figure out to tan acres is
the narratives or alsavhera.
SP_CIdL (TF.`i-DAY PROCESSING) operations must disturb LESS TEA.Y tan acres
(including all roads, stockpile areas and nay other surface facilities),
and can ONLY ba obtaiaad whore a federal, state, county, city, town or
spacial district contract calls for work to be cameunced vithia a SPFCIFiCALLY
SHORT TLS.
(Type or Print Clearl?)
I. name of operation ~
(Pit, mine or site Hama)
2. Vxae of applicant/operator
("lama to be used on permit)
3. :address and ohona number of
local Off ZCe9 / ~~ /S
•C 7l/ +/ /7 .Ll~
~.9
4. Address and ohona number of
. ganaral offices
5. Same and phone number of person /V ~ ~ -L
staff members should contact ~
o, Owner(;) of reeordof affected3nd
(sur.aca arraXlfaare etua2, 1'st below)
,. Owner(s) of substance to be wined T i
(If aura than 2, list below)
3. Sourea of legal right to enter
(Indicate what type of proof is
L ~v(/-
included Za E33IBIT G - lease,
deed, notarized latter, scc.)
?. Type of mina S substance ca ba
wined (3peci_'y underground, stria, L - 0 /OEN
oven pit, etc. S substance(s) to
be mined)
IO. General location & elevation ~ A-Q ~M~~ ~ y~7-Y EL 7/~d ,R
(:files S direction from nearest
cove S approxiaate site elevation) ~ ,_, , y_„ r. n . _ , f va ~, i i', .
I1. Connty
I~. ?,creage of affected Iands
(Total sur=aca acreage to be
included is per~.t) /~.. ~~~~
13. ?,oplicatian foe (See applicable _ o0
RLT.r. co determine amount) . ~ JS ~
I». Present Iaad use (_.e., agri- ~~/ /j~~~
C,1tur31, ir,duStr+31, etC.)
~]. Prepcs@d ftiLL•re land USe I
(GOaI Of rlClamaL3.Ott)

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