2011-06-08_REVISION - M1977256

• Permit No: M1977256
• IBM Index Class Name: Revision
• Doc Date: 6/8/2011
• Doc Name: Complete Application Form
• From: Grand County Dept. of Road & Bridge
• To: DRMS
• Type & Sequence: AM1
• Email Name: PSH
• Media Type: D
• Archive: No

-5-
Maps and Exhibits:
Two (2) complete, unbound application packages must be submitted. One complete application package consists of a signed application
form and the set of maps and exhibits refi renced below as Exhibits A-S, Addendum 1, and the Geotechnical Stability Exhibit. Each exhibit
within the application must be presented as a separate section. Begin each exhibit on a new page. Pages should be numbered consecutively
for ease of reference. If separate documents are used as appendices, please reference these by name in the exhibit.
With each of the two (2) signed application forms, you must submit a corresponding set of the maps and exhibits as described in the
following references to Rule 6.4, 6.5, and 1.62(1)(b):
E)GIIBIT A Legal Description
EXHIBIT B Index Map
EXl-IIBIT C Pre-Mining and Mining Plan Map(s) of Affected Lands
EXHIBIT D
EXHIBIT E
EXHIBIT F
EXHIBIT G
EXHIBIT H
EXHIBIT I
EXHIBIT .l
EXHIBIT K
EXHIBIT L.
EXHIBIT M
EX141BIT N
Mining Plan
Reclamation Plan
Reclamation Plan Map
Water Information
Wildlife Information
Soils Information
Vegetation Information
Climate Information
Reclamation Costs
Other Permits and Licenses
Source of'L.egal Right-To-Enter
EXHIBIT O Owners of Record of'Affected Land (Surface Area) and Owners of Substance to be Mined
EXI4IBIT P Municipalities Within Two Miles
EXHIBIT Q Proof of'Mailing ofNotices to County Commissioners and Conservation District
EXI-IIB1T R Proof'of Filing with County Clerk or Recorder
EXHIBIT S Permanent Man-Made Structures
Rule 1.6.2(1)(b) ADDENDUM 1 - Notice Requirements (sample enclosed)
Rule 6.5 Geotechnical Stability Exhibit (any required sections)
The instructions for preparing Exhibits A-S, Addendum 1, and Geotechnical Stability Exhibit are specified under Rule 64 and 6.5 and
Rule 1.6.2(1)(b) of the Rules and Regulations. If you have any questions on preparing the Exhibits or content of the information tequired,
or would like to schedule a pre-application meeting you may contact the Office at 303-866-3567.
Responsibilities as a Permittee:
Upon application approval and permit issuance, this application becomes a legally binding document. Therefore, there are a
number of important requirements which you, as a permitter, should fully understand. These requirements are listed below.
Please read and initial each requirement, in the space provided, to acknowledge that you understand your obligations. Ifyou
do not understand these obligations then please contact this Office for a full explanation.
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liability for all reasonable expenses which the Board or the Office may incur to reclaim the affected lands
associated with your mining operation in the event your permit is revoked and financial warranty is forfeited;