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STATE OF COLORADO <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 />CONSTRUCTION MATERIALS <br />REGULAR (112) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />.PU <br />CHECK ONE: E✓ There is a File Number Already Assigned to this Operation <br />PM - 20 _ 02 020 (Please reference the file number currentlyassignedD. sty <br />_ to this operatioajecutive Director <br />New Application (Rule 1.4.5) _n_ Amendment Application (Rule 1.10) mid W. Caw/Division Director <br />Conversion Application (Rule 1.11) Natural Resor Trustee <br />Permit # M - 2002 - 020 - (provide for Amendments and Conversions of existing permits) <br />COLORADO <br />DIVISION OF <br />RECLAMATION <br />MINING <br />SAFETY <br />Bill <br />Bill Ritter, Ir. <br />Governor <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. ADplicant/onerator or company name (name to be used on permit): City of Greeley <br />1.1 Type of organization (corporation, partnership, etc.): Municipality <br />2. Operation name (pit. mine or site name): 25th Avenue Site <br />3. Permitted serene (new or exisstins site): 89.16 permitted acres <br />3.1 Change in acreage (+) ' 197.53 • acres ' . <br />3.2 Total acreage in Permit area 286.67 acres <br />4. Fees: <br />4.1 New Application $2,696.00 <br />4.2 New Quarry Application $3.342.00 <br />4.4 Amendment Fee 52,229.00 <br />4.5 Conversion to 112 operation (set by statute) 52.696.00 <br />5. Primary commoditie(s) to be mined: sand <br />gravel <br />5.1 Incidental commoditie(s) to be mined: 1. n/a lbs/rons/vr 2. / <br />3. / lbs/Tons/vr 4. / <br />application fee <br />quarry application <br />amendment fee <br />conversion fee <br />lbs/rons/vr <br />lbs/rons/vr 5. / <br />lbs/rons/vr <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 />Office of <br />Mined Land Reclamation <br />Denver • Grandjunction • Durango <br />Office of <br />Active and inactive Mines <br />