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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 />CHECK ONE n <br />STATE OF COLORADO <br />CONSTRUCTION MATERIALS <br />REGULAR (112) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />COLORADO <br />DIVISION OF <br />RECLAMATION <br />MINING <br />—&— <br />SAFETY <br />NV i 7 201 <br />There is a File Number Already Assigned to this Operation <br />�7 0- <br />Permit # M - t9 ��r� 4 C1tio -%r in It) "7y <br />i d e' ' a -to (Please reference the file number currently assigned to this operation) (Ajt9 C n <br />1.1 <br />FrNew Application (Rule 1.4 5) Amendment Application (Rule 1.10) Cltr14- Re --CV Le <br />_ Conversion Application (Rule 1 11) <br />Permit # M - 19 9; <br />(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)' j : ;y' ,' J 3EL-1r 414')1.; -277;c- 1\1 _.; <br />1 1 Type of organization (corporation, partnership, etc ): /(;1 tv' 1:..AP <br />2 Operation name (pit, mine or site name) <br />3 Permitted acreage (new or existing site) <br />3 1 Change in acreage (+) <br />3 2 Total acreage in Permit area <br />Fees <br />4 1 New Application <br />4 2 New Quarry Application <br />-' 44..4 \ Amendment Fee <br />4 5 Conversion to 112 operation (set by statute) <br />. <br />5 Primary commoditie(s) to be mined`t ' ':, ti.( ! ?f},{ — '-..jf�F ; i, It–Tr t <br />5 1 Incidental commoditie(s) to be mined 1 j lb ons/yr 2 � <br />�' - c't'(' q �, f5it^':`' f lbs Tons%,yr <br />3 `7 w. 1�4 <br />t.-' lbsjons/yr 4. <br />5 2 Anticipated end use of primary commoditie(s) to be mined <br />53 <br />P <br />it7 permitted acres <br />C.14tA1ECi <br />acres <br />1 acres <br />$2,696 00 application fee <br />$3342.00__ quarry application <br />$2,229 00 'amendment fee <br />,696 Orr.'" conversion fee <br />lbs/Tons/yr <br />Anticipated end use of incidental commoditie(s) to be mined. '' I <br />5 <br />/ lbs/Tons/yr <br />y-iA- r2 "(.7.7 <br />="-4'7 s3.+ <br />1' <br />