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STATE OF COLORf~L~O <br />DIVISION OF MINERALS AND GEOLOGY <br />Department of Natural Resources <br />1313 Sherman SC, Room 215 <br />Denver, Colorado BD?03 <br />Phone: (303) 866-3567 <br />FAX: (303) 832-8106 <br />1.1 Type of organization (corporaflon, paztnership, etc.): Yar to <br />1.2 I.R.S. Tax ID No. or Social SectsityNumber: <br />Bill Owens <br />Governor <br />RECLAMATION PERMIT APPLICATION FORM Greg E. Watcher <br />Executive Director ' <br />Michael B. Long <br />Divisbn Director <br />The application for a Censttuction Materials Special 111 Operafion Reclamaflon Permit contains four major paz[s: (1) the applicaion form; <br />(2) Exhibits A-L, Addendum 1, and any sections of Exhibit 6.5 (Geo[echnical SCabilityExhibit), as required by the Office, and outlined in <br />Rules 6.1, 6.2, 6.?, 6.5, and 1.6.2(I)(b); (?) the applicafion fee; (4) the Performance Warranty andifrequired a Financial Warranty. When <br />you submit your applica*ion, be slue [o include one (1) completed, sieved and notarized IVORY ORIGINAL and one (1) copy of the <br />completed IVORY application form, iw0 (2) copies of Exhibits A-L, Addendum 1, appropriate sections of Exhibit 6.5 (Geotechnical Stability <br />Exhibit), as required, a check for the application fee described under (4) below, and the fully executed Performance Warranty and Financial <br />Warranty, if required. Exhibits should NOT be bound or in 3-ring binders; maps should be folded to 8 1/z' X 11" or 8 t/i' X 14" size. To <br />expedite processing, please provide the information in the format and order described in this form. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, all information described below. <br />Applicantloperator or company name (name to be rased on the permit): <br />2. <br />3. <br />4. <br />5. <br />6. <br />7. <br />s. <br />Operation name (pit, mine or site name): <br />Permifted acrease: <br />New.4nplica[ion: <br />i S, ~: fir <br />J:.i i.. 1JO 6~~4 <br />D)VISlON OF <br />MINERALS <br />GEOLOGY <br />RECLAMATION <br />MINING•SAFETY <br />.~~CBSaN~'OUIBTP <br />SPECIAL (111) OPERATION <br />CONSTRUCTION MATERIALS <br />Van ValkenburQ Pit <br />Acres <br />781.00 Application Fee <br />Priman'commoditie(s?tobemined: Rock Sand Gravel <br />Name ofolvnertothest¢faceofaffectedland: William Van Valkenburg ` <br />Name ofotwertothesubsnrfacerizbtsofaffectedland: William Van Valkenbur <br />Type of mining operation: R Surface ~ Underground ~ In-situ <br />9. Location information: The center of the azea where the majority of mining will occur: <br />COUNTY: Jackson <br />PRINCIPAL MERIDIAN (check one): X 6th (Colorado) ~ 10th (New Mexico) _ Ute <br />SECTION (write nltmber): S 2 3 <br />TOWNSIlIP (write number and check duection): T 6 X North `South <br />RANGE (write number and check direcfionj: R 81 _ East R -West <br />QUARTER SECTION (check one): X NE _ NW _ SE _ 5 W , <br />QUARTER/QUARTER SECTION (check one): _ NE _ NW _ SE ~ SW <br />GENERAL DESCRIPTION: (miles and direction from neazest town and the approximate elevation) 2 2 M i 1 e s <br />southtaest of Walden Co. on State Hwy 14 Elev.- Ft. <br />