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iii iiiiiiiiiiiii iii <br />999 <br />LIMITED LtiL°ACT (110) and <br />.~ECL4L TEN-DAY (111) PERMIT <br />_ APPLICATION FORM . <br />State of Colorado <br />Department of Natural Resources <br />MINED LAND RECLA.*fATION BOARD <br />1313 Sherman Street, Room 723 <br />Denver, CO 80203 (303) 839-3567 <br />,) { J •< <br />~ . ,yZ.~~ <br />IG <br />Application for Mining and <br />Reclamation Permit ,'pursuant <br />to CRS 1973, 34-32-101, et seq <br />.~ <br />~~ ~ L~_ <br />The following explanations cover Limited Impact applications (110's) and Special (Ten- <br />Day Processing)(111's) applications. In the interests of efficient processing, please <br />check the appropriate box to indicate which type of application you are applying for <br />here. 111 permits may be issued only under special circumstances. Be sure you are <br />eligible. <br />LLKITED PIPACT OPERATIONS must disturb LESS THAN ten acres (including all <br />roads, stockpile areas and any other surface facilities) over the life of <br />the mine, and must extract LESS THAN 70,000 tons of mineral, overburden or <br />combination thereof per calendar year. If the affected area is some fraction <br />greater than nine acres, be sure NOT to round this figure out to ten acres in <br />the narratives or elsewhere. <br />SPECIAL (TEN-DAY PROCESSING) operations must disturb LESS THAN ten acres <br />(including all roads, stockpile areas and any other surface facilities), <br />and can ONLY be obtained where a federal, state, county, city, town or <br />special district contract calls for work to be co®cenced within a SPECIFICALLY <br />SHORT TIME. <br />(Type or Print Clearly) <br />1. Name of operation <br /> (Pit, mine or site name) <br />2. Name of applicant/operator il]e a <br /> (Name to be used on permit) <br />3. Address and phone number of <br /> local offices <br />4. address and phone number of <br /> general offices <br />5. Name and phone number of person <br /> staff members should contact <br />6, Owner(;) of record of off ected 'and bpi 11 i am H. A~erc .Tr. <br /> (surface azea )( If more than 2 ,list below) <br />7. Ocrner(s) of substance to be mined <br /> (If more than 2, list below) <br />8. Source of legal right to enter <br />(Indicate what type of proof is <br /> included is EXHIBIT G - lease, <br />deed, notarized letter, etc.) <br />9. Type of mine 6 substance to be <br />mined (Specify underground, strip, <br /> open pit, etc. 5 substance(s) to <br />be mined) <br />Out of a hill. <br />10. General location & elevation <br />(Miles & direction from nearest <br />!' <br /> town b approximate site elevation) <br />11. Connty ::'organ <br />12. Acreage of affected lands <br />(Total surface acreage to be <br />included in pewit) <br /> <br />o ~ <br />13. application fee (See applicable <br />RUZE to determine account) <br />1,. Present land use (i.e., agri- <br /> cultural, industrial, etc.l <br />15. Proposed future land use ~- & wildlife uGe. <br /> (Goal of reclamation) <br /> <br />(over) <br />