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For Official Use Only <br />Date received: Submittal Completion: _ <br />Planning Comm. Date: B.C.C. date: <br />Dates of P.C. department meetings: <br />Other: <br />Staff contact/Case manager: _ <br />Fee Paid <br />-Time: <br />Note:. Petitioner should be a single ownership entity who owns the property. If property is leased, <br />landowner must co-sign application or submit a letter stating no objection. <br />Submittals - Please provide the following: <br />Cover application signed by all petitioners <br />E Legal Description* <br />10 Area Map* *See attached Site Plan <br />Vicinity Map* Submittal Guidelines <br />Existing Conditions Map* <br />Phasing plan sketch <br />Cross-section of cuts and fills <br />Reclamation plan sketch showing existing and final contours and landscaping <br />Certificate of liability insurance $600,000 with Routt County as additional named insured <br />u Names and mailing addresses on mailing labels of all property owners adjacent to the property on <br />which site is located as identified in the assessors records. Two sets are required. <br />Other: <br />Existing Conditions Map and Narrative <br />1. Area map. (Insert from Site Plan Description) See attached Map 1, PSCM 2010 Exploration <br />Program - Surface Ownership <br />2. Surface owner: State of Colorado, Sage Creek Holdings, LLC Wilton Earle & Sons, Public <br />Service of Colorado and Cross Mountain Ranch,LP. (See attached Map 1, PSCM2010 Exploration <br />Program - Surface Ownership) Access to surface estate is through existing surface use agreements <br />and patented rights (see Appendix A, Right-of-Entry for listing of access agreements). <br />Mineral owner if mineral exploration: Federal coal: State of Colorado coal; - I Old:; <br />(See attached Map 2, PSCM 2010 Exploration Program - Coal Ownership) (see Appendix A'for <br />listing of coal control agreements) <br />4. Lease interests: N/A <br />5. Covenants: (please attach): N/A <br />t. <br />Sage Creek Project - 2010 Program 2 02/24/10