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P STATE OF COLORADO <br />DIVISION OF RECLAMATION, MINING AND SAFETY <br />Deparkwd of Nadnal Resources <br />., <br />Fa a.OJ :a. U t•. <br />1313 Shennan SL, Room 215 <br />Denver, Colorado 80203 <br />Phone: (303) 865 -3567 <br />JAN 13 2015 <br />FAX (303) 832 -8108 <br />d V 0(� <br />DIVISION OF RECLAMATION <br />MINING AND SAFETY <br />CONSTRUCTION MATERIALS <br />LIMITED IMPACT (110) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />CHECK ONE: There is a File Number Already Assigned to this Operation <br />COLORADO <br />DIVISION OF <br />RECLAMATION <br />MINING <br />SAFETY <br />Permit # M - - (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 />i <br />Permit # M - - (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 xb); 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 NAT 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 />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, ALL information described below. <br />1. Aonlicaut/onerator or company name (name to be used on it) <br />perm: City of Holyoke <br />1.1 Type of organization (corporation, partnership, etc.): municipality <br />2. Operation name (pit. mine or site name): <br />3. Permitted acrem (new or ezistine site): <br />3.1 Change in acreage ( +) <br />3.2 Total Acreage in Permit Area <br />4. Fees: <br />4.1 New Application: <br />Amendment Fee (C.R.S. 34- 32.5- 125(II)): <br />Arthur -Mae Gravel Pit <br />Primary eommodhWs) to be mined: Gravel Dirt Barrow <br />9.9 permitted acres <br />acres <br />9.9 acres <br />$1258.00 application fee <br />827.00 application fee <br />5.1 Incidental commoditie(s) to be mined: 1. / lbs/Tons/vr 2. / Ibs/ToFms/vr 3. / lbs/Tons/vr <br />4. / lbs/Tons/yr 5. / lbs/Tons/vr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: <br />Anticipated end use of incidental commoditie(s) to be miffed: <br />road maintenance, bade fill material <br />