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7/78 •1111TED Ih1PACT (110) and • <br />SPECIAL TEtI-DAY (111) PERI1IT - III III'II~II'llllll <br />APPLICATION FORM <br />~~~~A` ~~~ sss <br />State of Colorado 1 4D Application for Mining and <br />Department of Natural Resources Reclamation Permit, pursuant <br />MINED LAND RECLAMATION BOARD SAAR 2 8 1983 ~ to CRS 1973, 31+-32-101, et seq <br />1313 Sherman Street, Room 723 <br />Denver, CO 80203 (303) 839-3567MINED LAND RECLAMATION <br />Coln Rant ~s ni....._-. ~___ $3 SO <br />The following explanations cover Limited Impact applications (IIOs) and Special (Ten- <br />Day Processing)(llls) applications. In the interests of efficient processing, please <br />check the appropriate box to indicate ~:l~ich type of application you are applying for her <br />~XX LIMITED IMPACT OPERATIONS must disturb LESS TITAN 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 />(~ figure out to ten acres in the narratives or elsewhere. ''~ <br />J is . <br />SPECIAL (TEN-DAY PROCESSING) operations must disturb LESS THAN ten acres cr. <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 />(Type or Print Clearly) <br />1. Name of operation State Land - Jensen Pit " <br /> ) <br /> (Pit, mine or site name <br />2. Name of applicant/operator State Department of Highways <br /> <br /> (Na~ae to be used on permit) <br /> Division of Highways - State of Colorado <br />3. Address and phone number of p,0. Box 850 Greele Colorado 80632-0850 <br /> local offices <br /> Ph. 353-1232 <br />4. Address and phone number of 4201 E. Arkansas, Denver, Colorado 80222 <br /> general offices <br /> _ _ _ Ph. 757-9224 _ <br />~5. Nane and phone number of person Ken Geisert V <br /> staff members should contact <br /> Ph. 757-9224 <br />6. Owner(s) of record of affected <br /> land (surface area) (If more State_ of Colorado <br /> than 2, list belew) <br /> State Land Board <br />7. Owner(s) of substance to be mined Same <br /> li <br /> st below) <br />(If more than 2, <br />8. Source of legal right to enter <br /> <br />(Indicate what type of proof is _ <br />Permit is being processed and will be submitted "' <br /> <br /> included in EXH131T G - lease, <br /> .deed, notarized letter, etc.) when obtained <br />9. Type of mine & substance [o be 5s <br /> <br />mined (Specify underground, strip, P <br />Open pit `~ ~fl `a" ~~ <br /> open pit, etc. E substance(s) Co <br /> be mined) _ <br />10. General location E elevation <br /> (Miles & direction from nearest Approximately 11 miles north and 1 mile east of <br /> [own E approximate site eleva- <br /> tion) 1101 oke: Approximate elevation is 3750 feet <br />11. County <br /> Sed wick ^_ <br /> <br />12. Acreage of affected lands <br /> (Total surface acreage to be <br />- included in ne mit) A ~rpximately 9.9 acres _ <br />13• Application fee (See applicable <br /> RULE to c'eterminc ar..ount) <br />(~,. ~r) <br />