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DIVISION OF RECLAMATION, MINING AND SAFETY <br />Department of Natural Resources <br />,we <br />STATE OF COLORADO <br />/111n 0 / <br />1313 Sherman St., Room 215 719958 05/28/2014 08:12 AM 6: 01008 P: 131 DOCUMENT <br />Denver, Colorado 80203 Peg*: 1 of 63 R $0.00 D $0.00 T $0.00 <br />Phone: (303) 866 -3567 Pamela M. Bacon Clerk 3 Recorder, <br />� Recorder,Logan County, Cc FAX: (303) 832-8106 ,III 11A1I I <br />II <br />"CONSTRUCTION MATERIALS <br />REGULAR (112) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />CHECK ONE: Lr L—_ There is a File Number Already Assigned to this Operation <br />Permit # M1.y78 - 249 (Please reference the file number currently assigned to this operation) <br />0— New Application (Rule 1.4.5) L— Amendment Application (Rule 1.10) <br />Conversion Application (Rule 1.11) <br />Permit # M 1978 249 - (provide for Amendments and Conversions of existing permits) <br />COLORADO <br />D I V I S ION OF <br />RECLAMATION <br />MINING <br />SAFETY <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 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 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. Applicant/omrator or company name (name to be used on permit): Logan County <br />1.1 Type of organization (corporation, partnership, etc.): County Government <br />2. Operation name (pit, mine or site name): Kokes Gravel Pit <br />3. Permitted acreage (new or existine site): <br />aO ' I permitted acres <br />3.1 <br />Change in acreage ( +) <br />RECEIVED <br />12— ° d acres <br />3.2 <br />Total acreage in Permit area <br />a <br />311 S— acres <br />N 19 2014 <br />NOV <br />4. Fees: <br />4.1 <br />New Application <br />DIVISION OF RECLAMATION 71V <br />$2,696.00 application fee <br />4.2 <br />New Quarry Application <br />MINING AND SAFETY <br />$3,342.00 quarry application <br />4.4 <br />Amendment Fee <br />$2,229.00 amendment fee <br />4.5 <br />Conversion to 112 operation (set by statute) <br />$2,696.00 conversion fee <br />5. Primary commoditie(s) to be mined: gravel <br />5.1 Incidental commoditie(s) to be mined: 1. - lbs/Tons/vr 2. _ / Ibs/Tons/vr <br />3. / lbs/Tons/vr 4. / lbs /Tons /yr 5. / lbs/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 />