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Tme-- <br />DIVISION OF RECLAMATION, MINING AND SAFETY <br />Department of Natural Resources <br />1313 Sherman St., Room 215 <br />Denver, Colorado 80203 <br />Phone: (303) 866 -3567 <br />FAX: (303) 832 -8106 <br />STATE OF COLORADO <br />CONSTRUCTION MATERIALS <br />COLORADO <br />D I V I S I ON OF <br />RECLAMATION <br />MINING <br />SAFETY <br />REGULAR (112) OPERATION R CED <br />RECLAMATION PERMIT APPLICATION FORM <br />CHECK ONE: There is a File Number Already Assigned to this Operation <br />JAN 2 8 2015 <br />Permit # M -!' 0 - 15 -003 (Please reference the file number currently assigned to this operatioW)vision of Reclamation, <br />� <br />New Application (Rule 1.4.5) Amendment Application (Rule 1.10) Mining &Safety <br />Conversion Application (Rule 1.11) <br />Permit # M - ?%y -_ 5 - �D3(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 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/operator or company name (name to be used on permit): New Cache La Poudre Irrigating Company <br />1.1 Type of organization (corporation, partnership, etc.): corporation <br />2. Operation name (Dit, mine or site name): New Cache Agricultural Pond 1 <br />3. Permitted acreaee (new or existine site): <br />12.02 <br />permitted acres <br />3.1 <br />Change in acreage ( +) <br />n/a <br />acres <br />3.2 <br />Total acreage in Permit area <br />12.02 <br />acres <br />4. Fees: <br />4.1 <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 />dirt gravel top soil <br />5. Primary commoditie(s) to be mined: <br />5.1 <br />Incidental commoditie(s) to be mined: 1. n/a - Ibs /Tons /yr <br />2. n/a / <br />lbs /Tons /vr <br />3. n/a / lbs /Tons/yr 4. n/a / lbs /Tons /yr <br />5. n/a / <br />lbs/Tons /yr <br />5.2 <br />Anticipated end use of primary commoditie(s) to be mined: fill for roads, oil & gas development, feedlot <br />5.3 <br />Anticipated end use of incidental commoditie(s) to be mined: n/a <br />