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iii iiiii1110 iiiniiim <br /> STATE OF COLOKAbO <br /> DIVISION OF MINERALS AND GEOLOGY <br /> DeF131 3Anknl of Nfluefl n,I I S of <br /> l J l)Sherman do Roan!I S <br /> Peon:,Col303)866-90207 I <br /> Phone:()031966-756f <br /> FAX:uon e3:.910e p DEPARTMENT OF <br /> RECEIVED ��/� �a RESOURI CES <br /> CONSTRUCTION MATERIALS /�'CJ� �j \ Rey Rome. <br /> APR 0 9 1999 Q / per" <br /> LIMITED IMPACT (110) OPERATION <br /> lamer S.lochl.ead <br /> Division of Minerals&Geology RECLAMATION PERMIT APPLICATION FORM Emull a Dl,tr o. <br /> Mkh,el 9.tmg <br /> DwMm 131W10, <br /> CHECK ONE: XX New Application (Rule 1.4) _ Amendment Application (C.R.S. 34-32.5-110) <br /> _ Conversion Application (Rule 1.11) <br /> Permit # Ei_ qa- - provide for Amendments and Conversions of exist- <br /> ing permits) <br /> This application for a Limited Impact (110) Operation Reclamation Permit contains three major <br /> parts: (1) the application form; (2) Exhibits A-J, Exhibit L, Addendum 1, any sections of Exhibit <br /> 6.5 (Geotechnical Stability Exhibit; as required by the Office, and outlined in Rules 6.1, 6.2, <br /> 6.3, 6.5 and 1.6.2(1) (b) ; and (3) the application fee. When you submit your application, be sure <br /> to include one (1) signed and notarized IVORY ORIGINAL and one (1) copy of the completed ivory <br /> application form, two (2) copies of Exhibits A-J, Exhibit L, Addendum 1, appropriate sections of <br /> 6.5 (Geotechnical Stability Exhibit) as required, and a check for the application fee described <br /> under Section (4) below. Exhibits should NOT be bound or in 3-ring binders; maps should be folded <br /> to 8 1/2" X 11" or 8 1/ " size. To expedite processing, please provide the information in <br /> 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 /> ------------------------------------------------------------------------------------------ <br /> 1. Applicant/Operator Name (name to be on Permit): Yuma County <br /> 1.1 Type of Organization (corporation, partnership, etc. ) : County Government <br /> 1.2 I.R.S. Tax ID No. or Social Security No. : 98-02621 <br /> 2. operation Name (Pit, mine or site name) : Adamson Bros. Mine <br /> 3. Permitted Acres (new or existing site) : 9.99 permitted acres <br /> 3.1 Change in (+ or -) ------ acres <br /> 3.2 Total acres in Permit area 9.99 acres <br /> 4. Fees: <br /> 4.1 New Application: $875.00 application fee <br /> 4.2 Amendment Fee: 4944,-" application fee <br /> 4.3 Conversion Fee ( from 110d to 110 5.4 conversion fee (Rule 1.11.2(2) <br /> 5. Primary commodities(s) to be mined: borrow dirt <br /> 5.1 Incidental commodities(s) to be mined: 1. / lbs/Ton/yr <br /> 2. / lbs/Ton/yr 3. / lbs/Ton/yr <br /> 4. / lbs/Ton/yr 5.' / lbs/Ton/yr <br /> 5.2 Anticipated and use of primary commodities(s) to be mined: Road construction. <br /> 5.3 Anticipated and use of incidental commodities(s) to be mined: <br />