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DIVISION OF RECLAMATION, MINING AND SAFETY <br />Department of Natural Resources <br />1313 Sherman St., Room 215 <br />Denver, Colorado 80203 <br />Phone. (303) 866 -3567 <br />FAX: (303) 832 -8106 <br />STATE OF COLORADO <br />CONSTRUCTION MATERIALS <br />REGULAR (112) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />t ORADO <br />SION O F <br />AMATION <br />INING <br />SAFETY <br />CHECK ONE: n There is a File Number Already Assigned to this Operation <br />Permit # M -_- (Please reference the file number currently assigned to this operation) <br />New Application (Rule 1.4.5) Amendment Application (Rule 1.10) <br />Conversion Application (Rule 1.11) <br />Permit # M -,� t O - C'V(provide for Amendments and Conversions of existing permits) <br />The application for a Construction Materials Regular 112 Operation Reclamation Permit contains three major parts: (l) the application <br />form; (2) Exhibits A -S, Addendum 1, any sections of Exhibit 6.5 (Geotechnical Stability Exhibit; and (3) the application fee. When you <br />submit your application, be sure to include one (1) complete signed and notarized ORIGINAL and one (1) copy of the completed <br />application form, two (2) 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 11" 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 requested below. <br />1. Avylicant/operator or company name (name to be used on permit): Washington County Road and Bridge District #3 <br />1.1 Type of organization (corporation, partnership, etc.): local government <br />2. <br />Operation name (pit, mine or site name): Yakutat Land Pit <br />3. Permitted acreage (new or eaistine site): <br />3.1 Change in acreage ( +) <br />3.2 Total acreage in Permit area <br />4. Fees: <br />4.1 New Application <br />4.2 New Quarry Application <br />4.4 Amendment Fee <br />4.5 Conversion to 112 operation (set by statute) <br />5. Primary commoditie(s) to be mined: Gravel Clay Sand <br />5.1 Incidental commoditie(s) to be mined: 1. - Ibs/Tons/yr <br />21.7 permitted acres <br />acres <br />21.7 acres <br />$2,696.00 application fee <br />$3,342.00 quarry application <br />$2,229.00 amendment fee <br />$2,696.00 conversion fee <br />2. / lbs/Tons /yr <br />3. / lbs/Tons/vr 4. / lbs/Tons/vr 5. / lbs/Tons/yr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: Road construction material <br />5.3 <br />Anticipated end use of incidental commoditie(s) to be mined: N/A <br />RECEIVED <br />Diviswi, vi i�� wndiUn, <br />Mining & Safety <br />