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c <br />~ .: <br />,:I~- -q9 <br />ie~a . <br />COLORADO DIVISION OF MINERALS AND GEOLOGY <br />1313 Sherman Street, Room 215, Denver, Colorado 80203, (303) 866-3567 ,....• ^ ,~, e~ ~q, D <br />JUN 012006 <br />APPLICATION FORM FOR A PERMIT <br />TO C~^ of ~~s and Geo1o~Y <br />CONDUCT COAL MINING IN COLORADO <br />Application to conduct surface or underground coal mining activities or other surface coal mining and <br />reclamation operations in Colorado pursuant to C.R.S. 34-33-101 et seq. <br />For an application to be deemed complete by the Division pursuant to C.R.S. 3433-103(5) and Rule <br />1.04(30), an applicant must: (1) supply all information as specified on this application form; (2) submit <br />five reproducible copies of the permit applicatron with original signatures; and (3) pay the appropriate fee <br />required by Rule 2.01.6. For federal mines, please refer to the Federal Agency Mailing List available <br />from the Division and provide one copy to each of the agencies on that list, at the same time the <br />application is submitted to the Division. Proof of distribution to the federal agencies should accompany <br />the application. Copies of application pages modified during the review process must be distributed in <br />the same manner, along with proof of distribution. <br />Please note that this form is only a listing of general category requirements and does not constitute a <br />check-ist of detailed permit application requirements. A finding of completeness should not be <br />interpreted to imply adequacy of an application. Additional information not fisted on this form may be <br />required for adequacy depending upon the individual circumstances of an application. After a decision <br />has been reached on this application, the operator must update the permit application on file at DMG <br />and OSM. <br />This form consists of two major parts: (1) a section entitled "Application General Operation Information: <br />and (2) a section entitled "Application Requirements." Specific instructions for filling in the necessary <br />information for each section appears immediately below the title of each section. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly the appropriate information as listed below. Supplemental sheets may be used <br />as necessary; such sheets must be attached to the form and referenced or keyed to the numbers on <br />the form. <br />1. Application Plumber (to be filled in by the Division): C - _ _. - _ _ _ <br />2. Permittee: N O R T H F I E L D <br /> <br />3. Mine/Site Name: ~ O R T H F I E L D_ M I N E <br />4. Current Perrnit Type: C O <br />