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<br />r <br />7/78 <br />LIMITED IMPACT (110) and <br />SPECIAL TEN-DAY (Ill) PERMIT <br />APPLICATION FORM <br />State of Colorado <br />Department of Natural Resources <br />MINED LAND RECLAMATION BOARD <br />1313 Sherman Street, Room 723 <br />Denver, CO 80203 (303) 839-3567 <br />~~CFI\I~® <br />S E P 2 4 1979 <br />f•~ifJED LAND RECLAMATION <br />• III III III IIIIIIIIII <br />~~y~/ <br />Application for Mining and <br />Reclamation Permit, pursuant <br />to CRS 1973, 34-32-101, et seq <br />~-,•~~ ~yo.7~- <br />The following explanations cover Limited Impact applications (11Os) and Special (Ten- <br />Day Processing)(llls) applications. In the interests of efficient processing, please <br />check the appropriate box to indicate which type of application you are applying for here. <br />LIMITED IMPACT OPERATIONS must disturb 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 THAF1 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 />figure out to ten acres in the narratives or elsewhere. <br />SPECIAL (TEN-DAY PROCESSING) 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 />SPECIFICALLY SHORT TIME. <br />r. -~ i~~o ~9-~ ~~ ~~ <br />(Type or Print Clearly) <br />1. Name of operation <br />i <br />) <br /> (Pit, m <br />ne or site name <br />2. Name of applicant/operator <br /> (Name to be used on permit) <br />3. Address and phone number of po,* ;~j~ 8447 <br /> local offices <br />303 ~~6-•5305 <br />4. Address and phone number of Same <br /> general offices <br />5. Name and phone number of person .~~ W. Crawford 303-325-~+7b5 <br /> staff members should contact <br />5. Owner(s) of record of affected <br />land (surface area) (If more <br />C. Peper <br /> than 2, list below) <br />L. Laugherty <br />7. Owner(s) of substance to be mined same <br /> (If more than 2, list below) <br />8. Source of legal right to enter <br />(Indicate what type of proof is ~ <br />Lease/ Cz ~F %~~-<~ ~P //ELY <br /> included in EXHIBIT G - lease, <br />deed, notarized letter, etc.) <br />9. <br />i Type of mine E substance to be <br />mined (Specify underground, strip, (a.•1 (app <br />~t~erground gold and siluer <br /> open pit, etc. E substance(s) to <br />be mined) <br />10. General location b elevation <br />(Miles E direction from nearest <br />S611BS iceat o; <br />Oura ~ <br /> town E approximate site eleva- <br />tion? <br />Il. County <br />moray <br />12. Acreage of affected lands <br />(Total surface acreage to be <br />included in ermi[ <br /> <br />two (2) acres <br />13. Application fee (See applicable <br />RULE to determine amount) <br />$3 5.00 <br /> <br />(over) <br />