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•IPIITEPERMITCAFPLDICASPECIAL (TTION FOR;t1AY) III IIIIIIIIIIIIIIII <br /> STATE OF COLORADO ° Co EI V D Application for inning <br /> 14ined Land Reclamation Board and Reclamation Permit, <br /> Department of Natural Resources r�r`B Pursuant to C.R.S. 1973, <br /> 1313 Sherman Street, Room 723 34-32-101, et seq. <br /> Denver, Colorado 80203 <br /> LIItITED IMPACT OPERATt:ONS '•niuse' distiutb'`LtE�-§'�ILSN 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 <br /> or combination thereof per calendar year. If the affected area is some <br /> fraction greater than nine acres, be sure NOT to round it up to ter. acres <br /> in the narratives or elsewhere. <br /> SPECIAL (TEN-DAY PROCESSING) operations must disturb LESS THAN ten <br /> acres (including all roads, stockpile areas and any other surface <br /> facilities) , and can ONLY be obtained where a federal, state, county, <br /> city, town, or special district contract calls for work to be <br /> commenced within a SPECIFICALLY SHORT TUIE. <br /> TYPE OR PRINT CLEARLY <br /> 1. Name of operations <br /> (Pit, mine, or site name) <br /> 2. Name of applicant/operator <br /> (Name to be used on permit) <br /> 3. Address and phone number of I _ <br /> local offices <br /> 4. Address and phone number SAME AS N3 ABOVE <br /> of general offices <br /> 5. Name and phone number of person —_ <br /> staff members should contact I _ <br /> 6. Owner(s) of record of affected <br /> land (surface area) <br /> (If more than 2, list below) <br /> 7. Owner(s) of substance to be mined SAME AS N6 ABOVE <br /> (If more than 2, list below) <br /> 8. Source of legal right to enter NOTARIZED LETTER <br /> (Indicate what type of proof is <br /> included in Exhibit G - lease, deed, <br /> notarized letter, etc.) <br /> 9. Type of mine & substance to be mined OPEN PIT - ROAD BASE MATERIAL <br /> (Specify underground, strip, open pit, <br /> etc. and substance(s) to be mined) <br /> 10. General location & elevation (`tiles APPROXIMATELY MILES _ OF <br /> 6 direction from nearest town 5 I ELEVATION FEET <br /> approximate site elevation) <br /> 11. County <br /> 12. Acreage of affected lands 5 ACRES OR LESS <br /> (Total surface acreage to be <br /> included in permit) <br /> {� ;7 <br /> 13. application fee (See applicable Rule $50 . 00 (' <br /> to determine amount) <br />