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DIVISION OF MINERALS AND GEOLOGY <br />Department of Natural Resources <br />3 ; 3 Sherman St . Room 215 <br />Oer.ver Colorado 80203 <br />,'hone 13031866.3567 <br />�.AX '3031832.3106 <br />CHECK OlvE y <br />STATE OF COLORADO <br />R i1t D A---4Vh, <br />CONSTRUCTION LViATERIALSS MAR 1� 2001 °' v I S I o .N <br />REGULAR (112) OPERATIOIoe � I N E RA I <br />RECLAINIATION PERMIT APPLICATI p ton of Minerals ant! Geololl EIN L O G <br />.'N !,,,, MrtC•SAFc "' <br />There is a File Number Already Assigned to this Operation <br />Permit # M -/ f -1-40 (please reference the 7nadment'Application c <br />urrentl assigned to this operation) <br />New Application (Rule 1.4.5) <br />(Rule I.10) <br />Conversioa Application (Rule I.11) <br />Permit # <br />M - 9_ <br />_-. (provide for Amendments and Conversions of existing permits) <br />Bill Owens <br />Governor <br />Greg E. Watcher <br />Executive Director <br />Michael 6, Long <br />Division Director <br />The application haits - for a Construction Materials Regular 112 Operation Reclamation Permit contains three major parts: (1) the application form; <br />(Z) Exhibits A S, Addendum 1, any sections of Exhibit 6.5 (Geotechnical Stability Exhibit; and (3) the application fee. When you submit your <br />application, be sure to include one (1) complete sinned and notarized IVORY ORIGINAL and four (4) copies of the completed Ivory <br />application form, five (�) copies of Exhibits A -S, Addendum 1, appropriate sections of 6.5 (Geotechnical Stability Exhibit, and a check for <br />the application fee described under Section (4) below. Exhibits should NOT be bound or in a 3 -ring binder, maps should be folded to <br />8 1/2" X 1 I" or 8 1/2" X 14" size. To expedite processing, please provide the information in the format and order described in this form. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, all Information described below. <br />1 • A ticant/o erator or com anv name name to be used on ermit : <br />.4A_ / > i <br />1 I Type of organization (corporation, partnership, etc.): A —Ai ' <br />1.2 I RS. Tax I.D. No. or Social Security Number: _ � % � /�j� �-- <br />2 Operation name (pit mine or site name): <br />3 Permitted acreage (new or exsting site): <br />3.1 Change in acreage ( +} <br />3.2 Total acreage in Permit area <br />4 Fees <br />4 l New Application <br />42 New Quarry Application <br />�45 dm�to <br />Con vers2 operation ( set by statute) <br />Primary commodities) to be mined: <br />5 1 Incidental commodities) to be mined: 1. A� <br />Ib ons/vr 2 <br />4 / <br />t Pined acres <br />acres <br />• acres <br />A2 34-4-00 application fee <br />—12--906.00 quarry application <br />—11-93 8-00 amendment fee <br />$2,344.00 conversion fee <br />lbs/Tonslvr 3, lbs/Toas/vr <br />lbslTons/vr /ronslvr <br />52 Anticipated end use of primary commodities) to be mined: <br />5 3 Anticipated end use of incidental commodities) to be mined: ��� <br />