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7178 •IMITED IAfPM~CT (110) ar~d • III'lllll'llllll'I~~.(~J~ <br />SPECIAL TEN-DAY,~(111) PERMIT <br />i- ~~ APPLICATION FORt•1 ' <br />State of Colorado Application for Mining and <br />Department of` Natural Resources Re {amation Permit, pursuant <br />MINED LAND P,ECLAMATION BOARD ~,'J ~ 0 1 1g8~cRS 1973, 34-32-101, et seq <br />1313 Sherman Street, Room 723 <br />Denver, CO 80203 (303) 839-3567 MI~eD LAl`1D RECLAM+aIIOPJ <br />The following explanations cover Limited Impact applications (110s) and Special (Ten- <br />Day Processing)(llls) applications. Ir, ±he interests of efficient processing, please <br />check the appropriate box to indicate which type of application you are applying for here. <br />LIMITED It1PACT OPERATIONS must d'+sturb LESS THAN ten acres (including <br />all roads, stockpile areas and any other surface facilities) over the <br />life of the mine, and must extract LESS THAN 70,000 tons of mineral, <br />overburden or combination thereof per calendar year. If the affected <br />area is some fraction greater than nine acres, be sure NOT to round this <br />fieure out to ten acres in the narratives or elsewhere. <br />SPECIAL (TEN-DAY PROCESSItJG) operations must disturb LESS THAN ten acres <br />(including all roads, stockpile areas and any other surface facilities), <br />and can ONLY be obtained where a federal, state, county, city, town or <br />special district contract calls for work to be commenced within a <br />SPE?IFICALLY SHGRT TIME. <br />(Type or Print Clearly) <br />1. Name of operation <br /> (Pit, mine or site name) <br />2. Name of applicant/operator <br /> <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 /> <br /> general offices <br /> ame _ <br />~~ <br />5• Name and phone number of person <br /> - <br />-- '-' <br /> staff members should contact - <br /> .. <br />6. Oom er(s) of record of affected <br /> land (surface area) (If more onn A. Calder <br /> than 2, list below) <br />7. Owner(s) of substance to be mined <br />a Y _ <br /> {If more than 2, list below) <br />8. Source of legal right to enter <br /> (Indicate what type of proof is o alt Contract Agreement <br /> included in EXHIBIT G - lease, <br /> deed, notarized letter, etc.) <br />9. Type of mine & substance to be <br /> mined (Specify underground, stri ~ _~__ <br /> open pit, etc. b substance(s) to . <br /> he mined) <br />10. Genera! location & elevation <br /> <br /> (Pules ~ Jirectio~~ fro„i n~ares~ ' <br /> taan E approximate site eleva- <br />t ion) •'- -- <br />~' ' oc-.., <br />ll. County <br />12. Acreage of affected lands <br /> (Total surface acreage to be <br />included in permit y <br />_ _, <br />13• Application fee (See applicable <br />RULE to determine amount) <br />~ ~~ lip[ ~,~t 4 ~/~ <br />l~-ai ~ O'~-11~ . <br />(ever) <br />s <br />;; <br />