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• <br />~ iii iiiiiiiiiiiii iii <br />10. Date activity is proposed to rak.n ence, Upon permit approval <br />Date activity is expected to be completed 2 Years from permi[ approval <br />11. Is any portion o1 the activity for whidt authorization is sought now complete? : ~ YES ® NO <br />II answer is "Yes" give reasons in the remark section. Month and year the activity was completed <br />Indicate the existing work on the drawings. <br />12. List all approvals or certi /ications required by other federal, interstate, state or local agencies for any structures, construc- <br />tion, discharges, deposits or other activities described in this application. <br />Issuing Agency Type Approval Identi lication No. Date of Application Dafe of Approval <br />Colo. Eater Quality <br />Control Commission Certification February 9, 1981 <br />~olo. ;tined Land Extraction and <br />Reclamation Board Reclamation Permit 78-287 October 25,1978 <br />13. Has any agency denied approval for the acti wiry described herein or for any acti wiry directly related to the activity <br />described herein? <br />a Yes © No (I1 "Yes" explain in remarks) <br />14. Remarks or additional information. <br />loo permanent structures are proposed for the site. Only processing equipment <br />(portable) will be installed, <br />15. Application is hereby made for a permit or permits to authorize the activities described herein. I certify that I am familiar <br />with the information contained in this application, and that to the best of my knowledge and belief such information is true, <br />complete, and accurate. 1 further certify that I possess the authority to undertak enn~tjhe^pro,,po-seDd activ/i~t'i e~s. <br />Signature of Applicant or Authorized Agent <br />Lloyd V. Barnhart/Consultant . <br />The application must be signed by the applicant; however, it may be signed by a duly authorized agent (named in Item 51 <br />it this form is accompanied bl' a statement by the applicant designating the agent and agreeing to famish upon request, <br />supplemental information in support of the application. <br />18 U. S, C, Section 1001 provides that: Whoever, in any manner within the jurisdiction of any department or agenry <br />of The United Stales knowingly and will}ally fat lilies, conceals, or covers up by any lridt, sdteme, or device a material fact <br />or makes any false, fictitious or lr audul ent statements or representations or makes or uses any false wri ling or doClment <br />knowing same to oon rain any false fictitious or lraudul ent statranenl or entry, shall be fined not more than 510.000 or <br />impri sioned not more than live years, or both, Do not send a permit processing lee with this application. Tha appropriate <br />lee will be assessed wften a permit is issued. ` <br />