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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 />LIMITED IMPACT (110) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />COLORADO <br />DIVISION OF <br />RECLAMATION <br />MINING <br />SAFETY <br />CHECK ONE Theereois'a'File Number Already Assigned to this Operation <br />Permit 4 M 0'VW 0(49 (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 - _ - (provide for Amendments and Conversions of existing permits) <br />The application for a Construction Materials Limited Impact (110) Operation Reclamation Permit contains three major parts (1) the <br />application form. (2) Exhibits A -J, Exhibit L, Addendum 1, any sections of Exhibit 6.5 and Geotechnical Stability Exhibit, as required by <br />the Office, and outlined in Rules 6 1, 6 2, 6.3, 6 5, and 1.6.2(1)(b), and (3) the application fee When you submit your app tication, he sure <br />to include one (1) complete signed and notarized ORIGINAL and one (1) copy of the completed application fonu, thvo (2) copies of <br />Exhibits A -J, Exhibit L, Addendum 1, and appropriate sections of 6 5 (Geotechnical Stability Exhibit), as required, and a check for the <br />application fee described under (4) below. Exhibits should NOT be bound or in a 3 -ring binder, maps should be folded to 8 1/2" X 11 " or 8 <br />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_ yoticant /operator or company name (name to be used on permit). Las Animas County <br />1.1 Type of organization (corporation, partnership, etc.) County <br />! Govemmeent <br />2 Operation name (pit, mine or site name). 1'1 E f A 0C / �"t J� Y4- / f 77 <br />3 Permitted acreatae (new or existing site): 8.5 permitted acres <br />3 1 Change in acreage ( +) acres <br />3 2 Total Acreage in Pennit Area acres <br />4. Fees <br />4 1 New Application. $1258.00 application fee <br />Amendment Fee (C R S 34 -32 5- 125(11)) $827.00 application fee <br />5 Primary commoditie(s) to he mined road base oversize rock <br />5 1 incidental conunodnic(s) to be nnned 1 / lbs /cons /vr 2 / Ibslfons/vr 3 / lbs/T'ons /vr <br />4 / lbs/1'ons /vr 5 / lbs/Tons /vr <br />52 Anticipated end rise of primary conuiioditie(s) to be mined County road and right of way maintenance <br />Anticipated end use of incidental comnioditie(s) to be mined• <br />RECEIVI =') <br />APR 0': 23 i I <br />Division of Reclamation, <br />Mining & Safety <br />