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CHECK ONE: LJ There is a File Number Already Assigned to this Operation <br />Permit # M - - (PIease 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 />Permit # M 179 -D59_ (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 I, 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 INFORIv1ATION <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): Coulson Excavating Co., Inc. <br />1.1 Type of organization (corporation, partnership, etc.): Corporation <br />2. Operation name (pit. mine or site name): Brownwood Pit <br />3. Permitted acreage (new or existing site): <br />3.1 Change in acreage (+) <br />3.2 Total acreage in Permit area <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 commodities) to be mined: SAND GRAVEL <br />5.1 Incidental commodities) to be mined: 1. - lbs/Tons/yr <br />3. / lbs/Tons/v4. ! Ibs/rons/vr <br />5.2 Anticipated end use of primary commodities) to be mined: ConstrU <br />5.3 Anticipated end use of incidental commodities) to be mined. NT Y <br />Q <br />148.7 permitted acres <br />0 acres <br />148.7 acres <br />$2.696.00 <br />STATE OF <br />COLORADO <br />DIVISION OF RECLAMATION, MINING <br />AND SAFETY <br />amendment fee <br />Department of Natural Resources <br />conversion fee <br />1313 Sherman St., Room 215 <br />Denver, Colorado 80203 <br />COLORADO <br />Phone (303) 866-3567 <br />p i V 15 i p N o r <br />RECLAMATIONMINING <br />FAX. (303) 832-8106 <br />SAFETY <br />CONSTRUCTION MATERIALS <br />REGULAR (112) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />CHECK ONE: LJ There is a File Number Already Assigned to this Operation <br />Permit # M - - (PIease 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 />Permit # M 179 -D59_ (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 I, 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 INFORIv1ATION <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): Coulson Excavating Co., Inc. <br />1.1 Type of organization (corporation, partnership, etc.): Corporation <br />2. Operation name (pit. mine or site name): Brownwood Pit <br />3. Permitted acreage (new or existing site): <br />3.1 Change in acreage (+) <br />3.2 Total acreage in Permit area <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 commodities) to be mined: SAND GRAVEL <br />5.1 Incidental commodities) to be mined: 1. - lbs/Tons/yr <br />3. / lbs/Tons/v4. ! Ibs/rons/vr <br />5.2 Anticipated end use of primary commodities) to be mined: ConstrU <br />5.3 Anticipated end use of incidental commodities) to be mined. NT Y <br />Q <br />148.7 permitted acres <br />0 acres <br />148.7 acres <br />$2.696.00 <br />application fee <br />$3342.00 <br />quant' application <br />$2.229.00 <br />amendment fee <br />$2.69600 <br />conversion fee <br />2. / lbs/fons/vr <br />5. / lbs/I'ons/vr <br />terials <br />'��!-".....•• : • o <br />COLORA <br />�2C.Prt �2C� <br />