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P"� NATE OF COLORADO
<br />DIVISION OF RECLAMATION, MINING AND SAFETY
<br />Department of Natural Res—rces
<br />1313 Sherman St., Room 215 T
<br />Dane, Cuhrado 80203 C O L O Rx n G
<br />—2015 X45 . . � 1 3 1 0
<br />Phone: (303) 866-3567 RECI.AMAr ON
<br />FAX: 1303/ 832-8106 M 1 N 1 N G
<br />SAFETY
<br />CONSTRUCTION MATERIALS REcew
<br />REGULAR 11 12) OYEKA i ium Is
<br />RECLAIVIA 1101-4 MK1V11 1 ArrLICA I ION r UlCV1 DEC 10 2015
<br />C;HhC& ONh: l here 6 as Nile 1V umber Already Abbigued to this Operation DW,, 110ryN OF RECOWAT1017
<br />Permit # 1V1 - -_ (rlca3c ,cfr,.m�cc tnc I11C uuIIIDc. CUIIO1Itly assiSIiCZI to tnis upcl'a'�O � D 5
<br />WETY
<br />New Application (Rule 1.4.5) AmenH■uCut Appl;eat;o,. (Rule 1. IU)
<br />Cgii V c. sii.0 Appl;catiou (KuIC L 1 I )
<br />Permit # M - - - (provide for Amendments and Con. ersiu..3 Of C, ;31;.,g pi.,ll,;t3)
<br />1 ne appkatim, Io. a C:oubt,uctiuu Mateuala Kegula, 112 Opelatiou KeCla„latlon Permit contains three major parts: (1) the application
<br />fou.; (L) hxh;b;ta A-5, AQacunuu. 1, any 3ectivua oI hxn;Dit b.J (C]eoteCnu;cal StaD;lity hnhitk- and (.i) the appl;Cat;ou tee. when you
<br />submit your application, be sure to ;nclude o..c (1) co..,plctc 3;g„ed a..Q uOtal;aC4 UKIGUNAL aua o..c (1) Copy oI the Cou,pleted
<br />application form, two (2) copies of Exhibits A -S, Addendum 1, appropriate sections of 6.J (Geotech..;cal Stab;l;ty h,n;b;t, m,'a a MOCK toi
<br />the application tee aesmibed under Section (4) below. Exhibits should NOT be bound or in a 3 -ring binder; maps should be fuldcd to
<br />8 CZ' x 1 1” o, 8 1 2" x 14" nice. 10 enpezlite p,oCebning, please prov;ae the information in the format and order described in this form.
<br />GENhKAL OFEKA I ION INFORMATION
<br />Type or print clearly, in the space provided, ALL information requc3lea Duda,...
<br />1. A Iicaut/v e.a[v. v. ai.w alix uau.e came tone u3ed oil e....it : Weld County Public Works
<br />1.1 Type of organization (corporation, partnership, etc.): L;uunty uuvernment
<br />2. UDerativu uaute (pit, oboe ur bite 11a,ue3: Palate 313 Pit
<br />3. rermittea acreage (ne.. o. a..i3ti.ig 3itell: 8U pennittCZI aC,e3
<br />3.1 Change in acreage (+) NA ac. e3
<br />S.2 1 utal amcase ;u Fe, uit a, ea NA acres
<br />4. C M:
<br />4.1 New Application $2,6yI5.69 application tee
<br />4.2 New quarry Application $3,342.00 quarry applicat;m.
<br />4.4 AILIG11ZI11ICI 1t 1'CC $2-229.00 amendment fee
<br />4.J l:v..Vc.317311 to 1 12 u clatluu act D AntutC
<br />Y (- y ) '$2,696.uu conversion fee
<br />5. Primary commoditie(s) to be mined: Sand and Gravel
<br />J.l lijuMmntal co,nn,odit;e(s) to be ,pined: 1. NR - Ibs/Tonslvr 2. lbs/Tons/yr
<br />J. I031Toua'V, 4. Ibb/ 1 uua/V, J. 1 Ib3/ lbnslvr
<br />5.2 Anticipated end use of primary commoditie(s) to be ...;..:d: ruga maintenanue ana wnstruutiun
<br />5.3 Anticipated mid use of incidental commoditie(s) to be mined:
<br />NA
<br />A r
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