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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 437: <br />RECLAMATION <br />MINING <br />SAFETY <br />CHECK ONE There isaFiille Number Already Assigned to this Operation <br />Permit 4 M �vW 12(9 (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 H M -. __ - (provide for Amendments and Conversions of existing permits) <br />The application for a Construction Materials Limited Impact (1 10) Operation Reclamation Permit contains three major parts (1) the <br />application form. (2) Exhubits 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 lication, be sure <br />to include one (1) complete signed and notarized ORIGINAL and one (1) copy of the completed application form, two (2) copies of <br />Exhibits A -J, Extubit L, Addendum 1, and appropriate sections of 6 5 (Gcotechtnical 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 i 1 " or 8 <br />1/2" X 14" size To expedite processing, please provide the information in the format and order described in this fonn <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, ALL information described below. <br />1. Appiicantfoperator or company name (name to be used on permit). Las Animas County <br />1.1 Type of organization (corporation, partnership, etc.) County Government <br />2 Operation name (pit, mine or site name). it`%C��� 0C MA YA �1 � <br />3 Permitted acreage (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(II)) $827.00 application fee <br />5 Primary commodities) to be mined road base oversize rock <br />if Tneiticntal conimoditic(s) to be ranted 1 / lbsrrons /yr 2 / Ibs/ronsh•r 3 / ibs/ *ons/vr <br />4 / lbs/i'ons /yr 5 / lbs/Tons /vr <br />52 Anticipated end tisc of prunary conumoditie(s) to be mined County road and right of way maintenance <br />Anticipated end use of incidental contmoditie(s) to be mined• <br />RECEI1b+=1 <br />APR 0C2�;� <br />Division of Reclamation, <br />Mining & Safety <br />