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STATE OF COLORADO <br /> DIVISION OF RECLAMATION,MINING AND SAFETY <br /> Department of Natural Resources <br /> 1313 Sherman St.,Room 215 710958 05/28/2014 08:12 AM B: 01008 P: 131 DOCUMENT C O L O R A D O <br /> Denver,Colorado 80203 Page: 1 of 63 R 0.00 D 0.00 T $0.00 D [V[S [O N OF <br /> Phone:(303)866-3567 Pamela M. Bacon Clerk & Recorrd`er,�,1L�ogan County, Cc RECLAMATION <br /> FAX:(303)832 8106 ,III K'AN f��111M 1M��Yrl1C1 91FA Wf�b 11111 MINING <br /> 1 SAFETY <br /> CONSTRUCTION MATERIALS <br /> REGULAR(112)OPERATION <br /> RECLAMATION PERMIT APPLICATION FORM <br /> CHECK ONE: ✓Q— There is a File Number Already Assigned to this Operation <br /> Permit# M11971 - 249 (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 1-978 249 _ (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(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 ofExhibits 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. ADvliontloverator or company name name to be used on permit): Logan County <br /> 1.1 ype of organization(corporation,partnership,etc.): County Govemment <br /> 2. Operation name(nit,mine or site name): Kokes Gravel Pit <br /> 3. Permitted acreaee(new or existine site): aO ' I permitted acres <br /> 3.1 Change in acreage(+) 1 2 1 acres <br /> 3.2 Total acreage in Permit area 3 vc acres <br /> 4. Fees: <br /> 4.1 New Application $2,696.00 application fee <br /> 4.2 New Quarry Application $3,342.00 quarry application <br /> 4.4 Amendment Fee $2,229.00 amendment fee <br /> 4.5 Conversion to 112 operation(set by statute) $2,696.00 conversion fee <br /> 5. PrimaEX commoditie(s)to be mined: gravel <br /> 5.1 Incidental commoditie(s)to be mined: 1. - lbs/Tons/vr 2. / lbs/Tons/vr <br /> 3. / lbs/Tons/vr 4. / lbs/Tons/vr 5. / lbs/Tons/vr <br /> 5.2 Anticipated end use of primary commoditie(s)to be mined: 'y�j O r to r'e-'-La m-a-41 Urr 0rN <br /> 5.3 Anticipated end use of incidental commoditie(s)to be mined: <br />