PERMFILE138846

• Permit No: M1975009
• IBM Index Class Name: Permit File
• Doc Name: LIMITED IMPACT 110 & SPECIAL TEN DAY 111 PERMIT APPLICATION FORM
• Media Type: D
• Archive: No

III IIIIIIIIIIIIIIII `SPECIAL TEN-DAYT (111),).PE,RMIT ,
CATION
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State of Colorado Application for Mining and
Department of Natural Resources p ",1
~ Reclamation Permit, pursuant
MINED LAND RECLAMATION BOARD ~~ '; to CRS 1973, 34-32-101, et seq
1313 Sherman Street, Room 723
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Denver, CO 80203 [phone] ~,
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The following explanations cover Limited Impact applications (110's) and Special (Ten-
Day Processing){ill's) applications. In the interests of efficient processing, please
check the appropriate box to indicate which type of application you are applying for
here. 111 permits may be issued only under special circumstances. Be sure you are
eligible.
(~ LIMITED IMPACT OPERATIONS must disturb LESS THAN ten acres (including all
K~ roads, stockpile areas and any other surface facilities) over the life of
the mine, and must extract LESS THAN 70,000 tons of mineral, overburden or
combination thereof per calendar year. If the affected area is some fraction
greater than nine acres, be sure NOT to round this figure out to ten acres ~in
the narratives or elsewhere.
D SPECIAL (TEN-DAY PROCESSING) operations must disturb LESS THAN ten acres
(including all roads, stockpile areas and any other surface facilities),
and can ONLY be obtained where a federal, state, county, city, town or
special district contract calls for work to be commenced within a SPECIFICALLY
SHORT TITSE.
(Type or Print Clearly)
1. Name of operation ~ P ~~
(Pit, mine or site name)
2. Name of applicant/operator
(Name to be used on permit)
3. Address and phone number of (~
local offices ~ _ O
4. Address and phone number of ~ L°•
general offices
5. Name and p:ione number of person ~ ~ ('
staff members should contact ~
6, Owner(s) of record of affected and ,~. ~ (,'
(surface azea X I f more than 2 , list below)
7. Owner(s) of substance to be mined e ,S' (/ ~.•
(If more than 2, list below)
8. Source of legal right to enter
(Indicate what type of proof is
(~ l°i , + ~ t.
included in EXHIBIT G - lease,
deed, notarized letter, etc.)
9. Type of mine & substance to be
mined (Specify underground, strip,
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open pit, etc. & substance(s) to
be mined)
10. General location 6 elevation
(Miles & di
ction f
t
re
rom neares
town & approximate site elevation) A F /,~ O
11. Connty F ~
12. Acreage of affected lands
(Total surface acreage to be
included in permit)

s C R e~
13. Application fee (Sze applicable
RULE to de[ermine amount) ry
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14. Present land use (i.e., agri- Q Q''
cult;:ral, industr_al, etc.)
15. Proposed future land use
(Goal of reci.?mationl

(over)