2013-09-11_REVISION - M1999033 ‎(6)‎

• Permit No: M1999033
• IBM Index Class Name: REVISION
• Doc Date: 9/11/2013
• Doc Name: New Amendment
• From: Fremont County
• To: DRMS
• Type & Sequence: AM1
• Media Type: D
• Archive: No

STATE OF COLORADO
DIVISION OF RECLAMATION, MINING AND SAFETY
Department of Natural Resources
1313 Sherman St., Room 215
Denver, Colorado 80203
Phone: [phone]
FAX: [phone]
CONSTRUCTION MATERIALS
LIMITED IMPACT (110) OPERATION
RECLAMATION PERMIT APPLICATION FORM
COLORADO
D I V I S ION Of
RECLAMATION
MINING
SAFETY
CHECK ONE: There is a File Number Already Assigned to this Operation
pn# M -99 -033 (Please reference the file number currently assigned to this operation)
New Application (Rule 1.4.5) —Z Amendment Application (Rule 1.10)
Conversion Application (Rule 1.11)
Permit # M -99 -033 - (provide for Amendments and Conversions of existing permits)
The application for a Construction Materials Limited Impact (I 10) I Is three major parts: (1) the
application form; (2) Exhibits A -J, Exhibit L, Addendum 1, any sect /'� tability Exhibit, as required
by the Office, and outlined in Rules 6.1, 6.2, 6.3, 6.5, and 1.6.2(1)(b) I`/) r ` 1 t I submit your application, be
sure to include one (1) complete signed and notarized ORIGINAL a ication form, two (2) copies
of Exhibits A -J, Exhibit L, Addendum 1, and appropriate sections of is required, and a check for
the application fee described under (4) below. Exhibits should NOT hould be folded to 8 1/2" X
11" or 8 1/2" X 14" size. To expedite processing, please provide thl described in this form.
GENERAL OPERATIO
Type or print clearly, in the space provided, ALL information described below.
1
2.
3
Analicant/onerator or comnanv name (name to be used on hermit):
1.1 Type of organization (corporation, partnership, etc.):
Oneration name (nit, mine or site name):
Permitted acreage (new or exi SL . ne site): RECEIVED
3.1 Change in acreage ( +)%
3.2 Total Acreage in Permit Area erp i i 2 n 1
4. Fees:
4.1 New Application:
Amendment Fee (C.R.S. 34- 32.5- 125(II)):
4.2 Conversion Fee (from 110d to 110 1
Fremont County Board of Commissioners
Government Entity
DIVISION OF RECLAMATION
MINING AND SAFETY
conversion fee (Rule 1. 11.2(2))
5. Primary commoditie(s) to be mined: Road Macen aI GravPl
5.1 Incidental commoditie(s) to be mined: 120,000 lbs /"F2 ns/3Lr
4. / lbs /Tons /yr
5.2 Anticipated end use of primary commoditie(s) to be mined:
Anticipated end use of incidental commoditie(s) to be mined:
9.00 permitted acres
'0.840 acres
9.840 acres
application fee
$ 827.00 application fee
2. / lbs /Tons /yr 3. / lbs /Tons /yr
5. / lbs /Tons /vr
Road Material
N/A