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_ • III IIIIIIIIIIIII III • <br />,. <br />~ APPLICANT'S QI~STIONF.....,~ ~..999~ .,.,.,..ADO DIVISION OF WILDLIFE <br />For Limited Impact Operations <br />(Permit 110-1 and 110-2) or <br />Regular Operations Permit 112) ~~CL-~~~tT ~ "' <br />Instructions to the a licant: Complete both sides of this form. Send the <br />comp e e orm o e appropr a e Division of Wildlife (DOW) Regional Manager. <br />g dependent Avenue Grand Junction, CO 81505 <br />NE Region: 317 W. Prospect Avenue Ft. Collins, CO 80526 <br />Central: 6060 Broadway Denver, CO 80216 <br />SW Region: 2300 S. Townsend Avenue Montrose, CO 81401 <br />SE Region: 2126 N. Weber Colorado Springs, CO 80907 <br />Re~ion_al Mana ers: <br />/NW Re ion: 7 In <br />To expedite processing, please provide the information in the format and order <br />described in this form. Type or print clearly. Incomplete questionnaires will be <br />returned. Please allow 30 days for processing of completed form. Your cooperation <br />is appreciated. <br />PLEASE ATTACH THE FOLLOWING INFORMATION TO THIS FORM: <br />A. Minin and Reclamation Plan: Oescriptlon oP proposed reclamation plan or <br />s t ing and Rec mat On Plan as prepared for MLRO application. <br />B. Mates: Submit copies of maps for the both the Mining Plan and the Reclamation <br />Plan. Suggested maps are those prepared for the MLRD application. <br />Far the 110-1 Permit, Two Acre Limited Impact Operation: Exhibit A - Location <br />Map Exhibit C - Affected Lands Map. <br />For the 110-2 Permit, Limited Impact Operation: Exhibit E - Mining Plan Map <br />and Reclamation Plan Map. <br />For the 112 Permit, Regular Operation: Exhibit C - Pre-Mining and Mining Plan <br />Map(s) of Affected Lands, and Exhibit F - Reclamation Plan Map. <br />- - - - - - - - - - - - - - - - - - - - - - - <br />1. Operation name (pit, mine): CIZ.oSS Mo.~wJfi<i~~J 1~- ~T" ND. <br />2. Application type (check one): Two Acre Limited Impact Operation (110-1) <br />Limited Impact Operation (110-2) <br />- _~Regular Permit Operation (112) <br />3. Name of applicant/operator: Mof-f~~ ~y.JT~ S2.on.~ l7¢~AQTME~Ji' <br />Address: p O • ~Ox ~C.-7 ~ ~,2.4i L~ lam. 8rG ZC. <br />Phone Number: 303- 8z-~- 3Zi ~ ~Jo,22rz,rJ ~ COOpE~L <br />20+40 5~~~-2al~SO2. <br />4. Name of contact person (if different from//above): Mg2.~/„J 1'~o02E <br />address: JS 70 2a~Jr.~n~...~, C~2~~y,~ e,,~ ti3l(aZS~ <br />Phone Number: 303 - vZ~f - 9 zs~9 <br />5. Location of mine: <br />(County, Tow <br />0 <br />9 <br /> <br />(OVER) <br />-10- <br />