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)( - ;O06 - oa 3 <br />STATE OF COLORADO <br />DMSION OF NNIMIS AND GEOLOGY r% ✓ <br />Depar"M of NOW RMUMes <br />1313 Sbeserton St., Rom 215 COLORADO <br />Deaver, Colorado 80203 DIVISION Of <br />M (M U663SU CONSTRUCTION MATERIALS M 114 R.A L S <br />FAX: 13031832.8108 REGULAR (I I2) OPERATION ' / G E O O G Y <br />$ECLAIVIATION PER?= APPLICATION FOR1V- <br />WOW" <br />Governor <br />t S'K ONF: Tbete IS a FBe Number Abudy Awkned ID 0& Opendan RWW George <br />Petnut d M — (Plan refermoe the file tevmber ceureatly wAped to thus operation) ftwdl`"e mvdw <br />RomN w. CdAW <br />New Application (Rule 1.4.5) Amendment Application (Rule 1.10) txMrtan p <br />CoWenba Application (Rule 1.11) Ndmrat Rw*U= rnraee <br />Permit d M - I (provide for Amendments and Converdons ofemsting permits) <br />The application for a Consou ction Materials Regular 112 Operation Reclamation Permit contains three major parts: (1) the application form; <br />(2) Exhibits A -S, Addendum 1. any sections of Exhibit 6.5 ( Stability Exhibit; and (3) the application I= When you submitpaut <br />application, be sure to include care (1) eomDlete darted and eoteoriaed Q-UQ A and one (1) copy of the completed application k m. two(2) <br />captesofExhibb A -S, Addendum 1, appropriate sections of6.3 (Geomecbmeal Stability Exhibit, and a check for the application fee ddesm1W <br />under Sechou(4) below. E*bitsAw id =beboundor in a 3•ringbimia;mep9 should befolded tag 1R" X 11 'orb IR' X 14'sixe. To <br />expedite proomwig, please provide the information in the format ad order described in this form <br />GENERAL OPERATION INFORMATION <br />Typo or print dearly. in "m spas provided, AU, i forn[ta *m >rewmted bd//o1�mr. lt <br />t. be lum an ITQtI "itU l:e?r�ora.Tr'oti%!/� <br />I.I Type of arpnblalion (corporatim partnessbip, etc.): r I-Q >. <br />2. Onerttioe <br />_name (o% mice or afte <br />namd ?Q rke .' — !J A.5 ha M <br />3. Perms <br />33 <br />emce=e (aesr or exbtins <br />Change in staeage ( +) <br />site): <br />ft f- E I M G V <br />pernutted acres <br />aersos <br />3.2 <br />4. ft: <br />4.1 <br />4.2 <br />4.4 <br />4S <br />Total acreage in Permit area r� <br />,�►� � 6 Lam+ <br />New ApplicationM <br />New Quarry Application pivisi� at L inarils ands 9 <br />Amendment Fee <br />Conversion to 112 operation (sat by statute) <br />ggEadltle(s) to be mb d: , PL4_ <br />5aa3 acres <br />52.344.00. application fee <br />QQ. quarry application <br />S I.9ma amendment fee <br />52.344.00 conversion fee <br />5.1 <br />Inrddeutal commodities) to be <br />mined: 1. Ilre/I artslvr 2. _ <br />/ lbsf�'ort4lir <br />5.2 <br />3. 1 ltss/totesh►t <br />Anticipated end use of primary <br />4. 1 ihs(feffik S. <br />commodities) to be mined: uns7 r✓efie►j <br />l l a <br />eLt�Q� <br />5.3 <br />Anticipated Std use of incidental commodities) to be mined: <br />office of t7Rioe of Geologialt Survey <br />Mined read Rectarrrattm Active and Inactive Miner <br />