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~' <br />999 <br />S Ep 2 ~9a6 LIMITED IMPACT (110) PERMIT APPLICATION FORM <br />_?"7.State'1of:.Colorado~~-' Application for Mining <br />Department of Natural Resources and Reclamation Permit, <br />MINED LAND RECLAMATION DIVISION pursuant to C.R.S. 1973, <br />1313 Sherman Street, Room 423 34-32-101, et sic, as <br />Denver, Colorado 80203 (303) 866-3567 ~ c~ '~ ~~~ amended. <br />1. Name of operation Cecil II Gravel Pit <br />(Pit, mine 'or site name) <br />2. Name of applicant/operator Washington County <br />(Name to be used on permit) <br />3. Address and phone number of <br />local offices <br />4. Address and phone number of <br />general offices <br />Washington County Courthouse <br />Akron, Colorado 80720 <br />Telephone: (303) 345-6565 <br />same as above <br />5. Name and phone number of <br />person staff members should <br />contact <br />6. Owner(s) of record of affected <br />land (surface area) <br />(If more than 2, list below) <br />7. Owner(s) of substance to be <br />mined <br />(If more than 2, list below) <br />Edward W. Cec11, Commissioner <br />c/o Washington County Courthouse <br />Telephone: (303) 345-2701 <br />Edward W. Cecil <br />Edward W. Cecil <br />8. Source of legal right to enter <br />(Indicate what type of proof <br />is included in Exhibit G) <br />Lease Agreement <br /> <br />