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<br />~; <br />i~ <br />__~ - <br />• , <br />-- ~ -- <br />Page 2 <br />REvU1,.9R (112) PERMIT APPLICATION FORM <br />STATE OF COLORADO Application for Mining and <br />Mined Land Reclamation Board Reclamation Permit, Pursuant <br />Department of Natural Resources [o C.R.S. 1973, 34-32-101 et seq. <br />1313 Sherman Street, Room 723. <br />Denver, CO 80203 <br />TYPE OR PRINT CLEARLY <br />=~~, <br /> <br />10, Type of mine 6 substance to be mined pit Gravel <br /> (Specify underground, strip, open pit, <br />d subotance(&) to be mined) <br />etc <br /> , an <br />11. General location b elevation (Miles a 3 miles south oP <br /> <br />" 6 direction from nearest town S <br />roximate site elevation) <br />a <br />o Collins • <br /> pp e <br />12, County R tER <br />13. Acreage of affected lands <br />(Total surface acreage to be <br /> included_in permit) <br />14. Application fee (See Rule 2 to ; 3 0 00 <br /> determine amount) <br />15. Present land use <br />ric <br />ltural <br />dustri <br />i <br />l <br />t <br />) <br />(i Ae•ricultural <br /> a <br />.e,, ag <br />u <br />, <br />n <br />, c <br />c. <br />16. Surrounding land uses ~ cry n rations <br /> " ... ,a <br />17. Proposed future land use • <br /> (Goal of reclamation) <br />18. Other mining permits 6 operations r tachad list and ~ <br /> in.Colorado (See Rule 2 for guidance) <br />19, The lands herein do not affect any of a ~ ~ is Trot located <br /> the lands described in Section <br />•1.56(9) (S ecify affirmation) <br />e~ ~ibed_in_ 1.56(9) <br />.. :Y <br />..( %~ <br />