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STATE OF COLORADO <br />DIVISION OF RECLAMATION, MINING AND SAFETY <br />,. Depaftentof Natural Resources Real Estate <br />1313 Sherman St., Room 215 JAN i <br />Denver, Colorado 80203 - O �1 COLORADO <br />DIVISION <br />Phone: (303) 866 -3567 RECLAMATION <br />FAX: (303) 832 -8108 <br />MINING <br />SAFETY <br />CONSTRUCTION MATERIALS <br />REGULAR (112) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />CHECK ONE: L1—_ There is a File Number Already Assigned to this Operation <br />Permit 4 MIS 80 183 (Please reference the file number currently assigned to this operation) <br />0— New Application (Rule 1.4.5) E — Amendment Application (Rule 1.10) <br />0— Conversion Application (Rule 1.11) ''-- --++'' <br />i <br />r <br />7 <br />Permit # M - 1980 163 (provide for Amendments and Conversions of existin <br />• g 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) eomnlete signed and notarized ORIGINAL and one (1) copy of the completed <br />application form, two (2) copies of Exhibits A -S, Addend-air. 1, appropriate sections of6.5 (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 />I. Applicant/overator or company name (name to be used on permit): <br />1.1 Type of organization (corporation, partnership, etc.): LLC <br />2. Operation name (pit, mine or site name): Pit 29 <br />3. Permitted acreage (new or existing site): <br />3.1 Change in acreage ( +) <br />3.2 Total acreage in Permit area <br />4. Fetes <br />4.1 <br />176.24 permitted acres <br />2.2 acres <br />178.42 acres <br />New Application <br />$2.696.00 <br />application fee <br />4.2 <br />New Quarry Application <br />$3,342.00 <br />quarry application <br />4.4 <br />Amendment Fee <br />$2.229.00 <br />amendment fee <br />4.5 <br />Conversion to 112 operation (set by statute) <br />$2.696.00 <br />conversion fee <br />5. Primary commoditie(s) to be mined: Aggregate Sand <br />5.1 <br />Incidental commodities) to be mined: 1. - lbs/Tons/vr 2. <br />/ <br />lbs/Tons/vr <br />3. / lbs/Tons/vr 4. / lbs/Tons/yrr 5. <br />/ <br />lbs/Tons/vr <br />5.2 <br />Anticipated end use of primary commodities) to be mined: Asphalt and Concrete <br />5.3 <br />Anticipated end use of incidental commodities) to be mined: Fill <br />1 <br />