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:, <br />~~~~~~~~ <br />~~ of co~o~9 ~ <br />DEPARTMENTOf NATURAL RESOURCES SFP ~ '; 1987 <br />~,o * David H. Catches, Execu„ive Director <br />MINED LANG <br />x•,8,6.. MINED LAND RECLAMATION DI?-~k~.~OKNION Dlt:, - <br />DAVID C. SH ELTOM'1, Diroetor <br />i <br />Richard D. Lamm ~ <br />Governor <br />r <br />Application Form for a Permit <br />! to - - <br />l Conduct Coal Mining in Colorado <br />l <br />Application to cor,~duct surface or underground coal mining activities or other <br />surface coal minfny and reclamation operations in Colorado pursuant to CRS, <br />34-33-101, et s~.q, <br />-!~ <br />For an application to be deemed complete by the Division pursuant to CRS, <br />34-33-103(5) and Rule 1.04(30), an applicant must: (1)~suppTy all information <br />as specifier('on this application form; (2) submit five reproducible copies of <br />the permit application with original signatures; and (3) pay the appropriate <br />fee required by Rule 2.01.6. <br />Please node that this form is only a listing of general category requirements <br />and does not constitute a checklist of detailed permit application <br />requirements. A finding of completeness should not be interpreted to imply <br />adequacy of an application. Additional information not listed on this form <br />may be required for adequacy dependinG upon the individual circumstances of an <br />applic tion. <br />This form consists of two major parts: (1) a section entitled General <br />Operation Information and (2) a section entitled Ap lication Requirements. <br />Specific instructions for filling in the necessary in ormation or eac <br />section appears immediately below the title of each section. <br />GENERAL OPERATION INFORMATION <br />L~ <br />Type or print clearly the appropriate information as li.ste.d below. <br />Supplemental sheets may be used as necessary, such sheets must be attached to <br />the form and referenced or keyed to the numbers on the form. <br />1. Application Number (to be filled in by the Division): C- 5 3 - 8 I <br />2. Permittee F I D E <br />- - - - L <br />- L O S <br />- - - - A T <br />- - O <br />- - - - - - - - - - <br />3. Mine or• Site Name: a <br />- L <br />- U E F <br />- - - - L A <br />- - M E C 0 A L C 0. <br />- - - - - - - - - - <br />4. Currt•rt Permit Type: C 0 <br />5. Application Submittal Date 0 5 /1 2/ 8 6 <br />6. Application Fee: E 4 2 5. 0 D Incremental Fee Schedule: _ <br />7. Commodity Mined: C 0 A <br />423 Centennial Building, 7313 Sherman Street Denver, Colorado 80203 Tel. (303) 866-3567 <br />._ 1~ <br />