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DEPARTMENT OF PLANNING SERVICES <br />1555 N. 17th Avenue, Greeley, Colorado 80631 <br />Phone (970) 353-6100, Ext. 3540 Fax (970) 304-6498 <br />USE BY SPECIAL REVIEW (MINING OPERATION) APPLICATION <br />FOR THE DEPARTMENT OF PLANNING SERVICES USE ONLY <br />Application Fee Receipt Number ~ Case Number <br />Recording Fee Receipt Number Zoning District <br />Application Checked By: Planner Assigned to Case <br />To be completed by APPLICANT is accordance with procedural guide requirements: <br />I (we), the undersigned, hereby request a hearing before the Weld County Planning Commission concerning <br />a proposed 4ravel (gravel, coal, borrow pit, etc.) mining operatior~for the following described <br />unincorporated area of Weld County: to add structures <br />LEGALDE:SCRIPTION: Sections 16 & 21, T2N, x68W <br />PARCEL NUMBER: _ deg ~tt~c>~~ _ _ _ _ _ (12 digit number -found on Tax I.D. Information or <br />obtained at the Assessor's Office). <br />2. Surface owner(s) of area of land described <br />Name: rnoh;l pr m,x rbn rp rnc_ Address: arra~r,P,~ Phone: attached <br />Name: Address: Phone: <br />3. Owner(s) of mineral rights or substance to be mined <br />Name: Mobile premix Concrete, Inc. Address: attached phone: attached <br />Name: Address: Phone: <br />4. Sourcr: of applicant's legal right to enter and to mine on the land described: <br />warranty deeds attached as Exhibit D <br />(Include certified copy of any document(s) noted . <br />5. Applicr3nt's address: see attached Phone: <br />Address: Phone: <br />6. IdenliF)~ any prior permits for mining held by applicant or affiliated person: <br />7. Description of Operation <br />A. Types and number of operating and processing equipment to be <br />see attached <br />B. Maximum number of employees: see attached ,and number of shifts: see attached <br />C. Number of stages to be worked: 5 .and periods of time each is to be worked 2- 'r lea r= <br />_ ac nrPVio,cly aY ~rroved <br />14 <br />