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~ - • IIIIIIIIIIIIIIIIIII- ~ ,/ ~ ~~~~~ <br />sss REGULAR (1~ ~Eiuh~L~N PORM / '~"~ .A ,/ p,. - <br />STATE OF COLORADO Application for Mining and <br />Mined Land Reclamation Board JUG! ~~j 1918 Reclamation Permit, Pursuant <br />Department of Natural Resources to C.R.S. 1973. 34-32-101 et a <br />1313 Sherman Street, Room 723 (,gINED LAND RECLAMATION <br />Deaver, CO 80203 ~~~;. Deni o! !+!s?ura! P,~sc_rces <br />_ --- - - -- -- TYPE OR PRINT CLEARLY U/~~{~r~"'t ~ / 7 ~~D <br />1. Name of operations ~,~~( ,j S ~[ICUN~ <br />~kC• <br /> (Pit, mine, or site name) _ <br />~. - <br />2. Name of applicant/operator ~~~is ~~{ ~", ~ ~~,. v t~i~e ~~I~~~~iGS --l~U) is fc+ <br />~ <br /> {Name to be used on permit) •'-T~ <br />G t, <br />3. Address and phone number of ~~ ~~ )~ <br /> local offices ~S. ~ <br />.• <br />4. Address and phone number -~~~~f' <br /> of general offices <br />5. Name and phone number of person )~ ~ L ' ~j' S <br /> staff members should contact ,~ •_ i _ ~ <br />6. Parent Corporation, if any <br /> (Include name b address) <br />7 Owner(s) of tncord of affected ~/ ~ <br />. land (surface area) <br /> (If more than 2, list in Exhibit P) <br />8. Owner(s) of substance to be mined ~ S ~ ~ ~ <br /> (If more than 2, list in Exhibit P) <br />9. Source of legal right to enter ., ~ U ~ ~- ~~ )~ ~ <br /> (Indicate what type of proof ie <br />included is Exhibit 0 - lease, deed, <br /> notarized letter, etc.) <br />10. Type of mine b substance to be mined ` <br /> (Specify underground, strip, open pit, <br /> etc. and substance(s) to be mined) <br />11. General location b elevation (Miles ~ I I <br /> S direction from nearest town b <br />C" ) ~~ ~`~ <br /> approximate Bite elevation) e <br />12. County - ~' <br />13. Acreage of affected lands <br />(Total surface acreage to be <br />Cvc?S <br /> included in permit) <br />14. Application fee (See Rule 2 to 3¢~(~ aD0 <br /> determine amount) <br />15. Present land un~ ~ ,D <br /> (i.e., agricul.cural, industrial, etc.) <br />_ ~.~ I_ <br />16. Surrounding land ~ise:r - <br /> <br />17. Proposed future land use ~ r Gf/' `, <br /> (Goal of reclamation) ~ Y <br />18. Other mining permits 6 operations <br /> in Colorado (See Rule 2 for guidance) <br />19. The lands herein do not affect any of <br /> the lands dee~:ribed in Section <br />1.56(9) S ecif affirmation) <br />~i <br /> <br />