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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 />REGULAR (112) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />CHECK Ohl: �_ There is a File Number Already Assigned to this Operation <br />COLORADO <br />DIVISION OF <br />RECLAMATION <br />MINING <br />SAF ETY <br />Permit # M - - _ (Please reference the file number currently assigned to this operation) <br />New Application (Rule 1.4.5) L� Amendment Application (Rule 1.10) <br />Conversion Application (Rule 1.11) <br />Permit # ___M lj85 11 (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 sip <br />ned 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 />Applicant /operator or company name (name to be used on permit: Loloff Construction, Inc. <br />1.1 Type of organization (corporation, partnership, etc.): Corporation <br />2. Operation name (pit, mine or site name): <br />3. Permitted acreage (new or existine site): <br />3.1 Change in acreage ( +) <br />3.2 Total acreage in Permit area <br />Loloff Pit <br />4. Fees: <br />4.1 New Application <br />4.2 New Quarry Application <br />4.4 Amendment Fee <br />4.5 Conversion to 112 operation (set by statute) <br />5. Primary commoditie(s) to be mined: Sand Gravel Soil <br />5.1 Incidental commoditie(s) to be mined: 1. lbs-Tons %xr <br />55.17 existing permitted acres <br />0 acres <br />55.17 total acres <br />$2,696.00 <br />application fee <br />$3342.00 <br />quarry application <br />$2,229.00 <br />amendment fee <br />$2.696.00 <br />conversion fee <br />2 / Ibs /Tons /yr <br />3. / Ibs /Tons /yr 4. lbs- Tons'yr 5. / Ibs /Tons /yr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: Construction Materials <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: N/A <br />