2009-08-05_PERMIT FILE - M2009060

• Permit No: M2009060
• IBM Index Class Name: PERMIT FILE
• Doc Date: 8/5/2009
• Doc Name: New 112c application
• From: Moffat County Board of County Commissioners
• To: DRMS
• Email Name: GRM
• Media Type: D
• Archive: No

Exhibit H- I (Page 1)
Appendix A.
APPLICANT'S QUESTIONNAIRE TO THE COLORADO DIVISION OF WILDLIFE
For Limited Impact Operations
(Permit 110-1 and 110-2) or
Regular Operations Permit 112)
Instructions to the applicant: Complete both sides of this form. Send the
completed orb m to the appropriate Division of Wildlife (DOW) Regional Manager.
Regional Managers:
NW Region: 711 Independent Avenue Grand Junction, CO 81505
NE Region: 317 W. Prospect Avenue Ft. Collins, CO 80526
Central: 6060 Broadway Denver, CO .80216
SW Region: 2300 S. Townsend Avenue Montrose, CO 81401
SE Region: 2126 N. Weber Colorado Springs, CO 80907
To expedite processing,- please provide the information in the format and order
described in this form. Type or print-clearly. Incomplete questionnaires will be
returned. Please allow 30 days for processing.of completed form. Your cooperation
is appreciated.
PLEASE ATTACH THE FOLLOWING INFORMATION TO THIS FORM:
A. Minim and Reclamation Plan-., Description of proposed reclamation plan or
submit Mining and Reclamation Plan as prepared for MLRD application.
B. Maps: Submit copies of .maps for the both the Mining Plan and the Reclamation.
Pte. Suggested maps are those prepared for the MLRD application.
For the 110-1 Permit, Two Acre Limited Impact. Operation: Exhibit A - Location
Map Exhibit C - Affected Lands.Map.
For the 110-2 Permit, Limited Impact. Operation: Exhibit E - Mining Plan Map
and Reclamation Plan Map.
For the 112 Permit, Regular Operation - Exhibit C - Pre-Mining and Mining Plan
Map(s) of Affected Lands, and Exhibit-F - Reclamation Plan Map.
- - - - - - - - - - - -
1. Operation name (pit, mine):- Clay. Pit No. 21
2. Application type (check one.): Two Acre Limited Impact Operation (110-1)
Limited Impact Operation (110-2)
XXX Regular Permit Operation (112)
3. Name of applicant /operator:Moffat; County Board of County Commissioners
In Care of Moffat Count y`Road Dee amen
Address: P.O. Box 667, Craig,-- COY-4626 Bill Mack (Director)
Phone Number: [phone]
4. Name of contact person (if different from.-above)., Marvin Moore (Consultant)
Address • 1570 Ranney, Craig, Co .81625.
Phone Number: [phone]
5. Location of mine: Moffat C
(County, Township, Rangy
(OVER)
T9N.0 R96W, Sec. 109 S
;ion to nearest quarter qi
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