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-'e y <br />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 />CHECK ONE: W1 There is a File Number Already Assigned to this Operation <br />ALORADO <br />DIVISION Of <br />RECLAMATION <br />MINING <br />SAFETY <br />4 AF & Report <br />4 MV-2010-03401/131201- <br />Pemut # W%0 134 (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 it M - 1990- 134 _ (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 application, 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, 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 81 /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 />2. <br />3. <br />4. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, ALL information described below. <br />Applicant/operator or company name (name to be used on Permit): James H Ross &Katthleen H Ross <br />1.1 Type of organization (corporation, partnership, etc.): <br />Operation name (pit, mine or Litt nee): Ross Pit <br />Permitted acreage (new or existine site): <br />3.1 Change in acreage ( +) <br />3.2 Total Acreage in Permit Area <br />Fees: <br />4.1 New Application: <br />Amendment Fee (C.R.S. 34- 32.5 - 125(11)) <br />6.92 permitted acres <br />2.64 acres <br />9.56 acres <br />58.00 application fee <br />827.00 application fee <br />S. Primary commoditie(s) to be mined: sand& 9--1 fill dirt <br />5.1 Incidental commoditie(s) to be mined: 1. 5000 / -' Ibs/Tons/yr 2. 1000 lbs/Tons/vr 3. 1 I�s/Tons/yr <br />4. ! Ibs/Tons/yr 5. ! Ibs/Tons/vr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: construction materials <br />Anticipated end use of incidental commoditie(s) to be mined: construction materials <br />a� <br />I` �/�� APR 15 2014 <br />Division of f Reclamation, <br />� Mining & Safety <br />