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STATE OF COLORADO <br />DIVISION OF RECLAMATION, MINING AND SAFETY. <br />Department of Natural Resources L? <br />1313 Sherman St., Room 215 <br />Denver, Colorado 80203 <br />COLORADO <br />Phone: (303) 866 -3567 <br />1 V I S i ON OF <br />FAX: (303) 832.8106 <br />rtEOLWMN <br />RECLAMATION <br />MINING <br />N; .� <br />—&— <br />SAFETY <br />CONSTRUCTION MATERIALS <br />REGULAR (112) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />CHECK ONE: 9 There is a File dumber Already Assigned to this Operation <br />Permit # - -M ;Z -o13 - (Please reference the file number currently assigned to this operation) <br />New Application (Rule 1.4.5) Amendment Application (Rule 1.10) IJ,) 64 t <br />Conversion Application (Rule 1.11) <br />Permit # M --Q-L3 - - (provide for Amendments and Conversions of existing permits) <br />The application for a Construction Materials Regular 112 Operation Reclamation Permit contains three major parts: (1) the application <br />form; (2) Exhibits A -S, Addendum 1, any sections of Exhibit 6.5 (Geoteehnical Stability Exhibit; and (3) the application fee. When you <br />submit your application, be sure to include one (1) com lete signed and n t riz d 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 lit" X t l" or 8 U2" 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. Applicant /operator or companN name (name to be used on permit) JoFW PtNp _ 2)*ENy_4A <br />1.1 Type of organization (corporation, partnership, etc.). ,SM1MAAQ*,k _ aignmi a ge{ <br />2. Operation name (pit mine or site name): __PIT M:-_ <br />3. Permitted acreage (new or existing 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 />47 �� permitted acres <br />acres <br />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 />5. Primary commodities) to be mined: 5A N.D /u- <br />5.1 Incidental commoditie(s) to be mined: 1 _- _ _ lbsrfpns,'yr 2. _ _ _ _ !bs/Tonsyr <br />3• _ _ —AN Tonsyr 4. Ibs/Tons�r S. __ -- -_ Ibs/Tons /vr <br />5.2 Anticipated end use of primary commoditie(s) to be mined.. <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: <br />,/ <br />vu U 10(OAi o�' <br />