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<br />sss L=rITED L
<br />~'ACT (110) a-d ~
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<br />S?°_CL1L TEV-DAY (111) ?°_R_`;IT e
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<br /> .;.°PI.~'1~`!~7!"C~r_~>^±AT!") a 2'e ~` `, lll...111 _ 7Y
<br />State of Colorado application for `fining and
<br />Departeat of Vatural Resources ,~ ,,,
<br />~~~~ declamation ?craft, pur suant
<br />2TrED LAND RECSaw~TION BOARD - ~ to CRS 1913, 34-32-101, ec seq
<br />I3I3 Shemaa Street, Roam 423
<br />Deaver, CO 80203 (303) 839-3567
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<br />The Following explanations cover Limited Impact applications (110's) and Special (Ten-
<br />Day Processing)(I11's) applications. Ia the interests of efficient processing, please
<br />check the appropriate box to indicate which type of applicaticn you are applying for
<br />here. II1 petmi.ts may be issued only wader special circumstances. Be sure qou are
<br />eligible.
<br />LI:*S:'~~' Z_`lP9CT OP~aTIOCrS must disturb LESS THA+v ten acres (including all
<br />roads, stockpile areas and nay other surface facilities) over the life of
<br />the mice, and moat extract LESS THA.`I 70,000 tons. of mineral, overburden or .
<br />camhiaatian thereof par calendar year. If the affected area Ss some fraction
<br />greaCer than nine acres, be sure VOT Co round this figure cut to ten acres is
<br />the narratives or elsewhere.
<br />0 SPECIAL (TEI-DAY PROCESSLYG) operations must disturb LESS THA27 tea acres
<br /><iaeludf,ag all roads, stockpile areas and nay other surface facilities),
<br />and can ONLY be obtained where a federal, state, county, city, town ar
<br />spacial district contract calls for work to be commenced within a SPECIFICALLY
<br />S80RT TLYE.
<br />(Type or Print Clearly)
<br />I. name of operation ~ , Je(~~' h ~ 1~ ~ l~ 1.f/.7 Y'1^ 1 Phi
<br />(Pit, mina or site name) ~ ~~~ ~ ~ ~ ~ h
<br />?. :tame of applicant/operator yQ
<br /> (Name to be used on permit)
<br />3, address and phone number of ~~• ° ~ JC
<br /> local offices
<br />o. f
<br />4, address and phone number of
<br /> general offices
<br />5. Vane and phone number of person
<br /> staff nembars should contact
<br />g, Owner(;) of record of affected land ~'
<br /> (sur'_ace areaXIfmarettsaa2, 1st oelow)
<br />7. Owner(s) of substance to be aiaed
<br /> (If sore than 2, list below)
<br />8. Source of legal right to eater
<br />(Indicate what eypa of proof is
<br />'~ Q J ~~
<br /> included in E3318TT G - lease,
<br />deed, notarized letter, etc.)
<br />9. Type of mine fi substance co be
<br />mined (Speei_Fy underground, strip, ~,
<br /> open pit, etc. fi substance(s) Co
<br />be aiaed) ~
<br />O e-~ ~~
<br />"
<br />I0. General location & elavatiaa
<br />/V:T ss C d:-nwN n., Frrw .. nr _ ~ e ~ Q ~ ~
<br />tovn fi appropriate site elevation)' ~ ,
<br />11. Connty
<br />L2. acreage of affected lands
<br />(Total surface acreage to ba V
<br />~cluded in permit) ~ ~~? I
<br />I3. application fee (See applicable ~ ~ r b r 3 QCreS
<br />RLZE to determine amount) ~-' '~ - ~ ~
<br />t ;. ~
<br />Present Land use (i.e., Agri- O e ~
<br />- cut=a-a2, iaduscria'_, etc.)
<br />_13. ?reposed future land use ~ `~)) « ~ I~P_
<br />(Goal of raclamaticn)
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