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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 />AMO2 <br />',compiled! <br />0 Violations <br />*No Check Included!! <br />COLORADO <br />DIVISION OF <br />RECLAMATION <br />MINING <br />SAFETY <br />CONSTRUCTION MATERIALS <br />REGULAR (112) OPERATION RIC Lt - <br />RECLAMATION PERMIT APPLICATION FORM <br />,JAN 1 k°16 <br />OMSION OF RECLAMATION <br />(Please reference the file number currently assigned to thii19 SAFETY <br />CHECK ONE: ri There is a File Number Already Assigned to this Operation <br />Permit # M - <br />B._New Application (Rule 1.4.5) <br />C i sion Application (Rule 1.11) <br />Amendment Application (Rule 1.10) <br />Permit ; 5 I (p •vide for Amendments and Conversions of existing permits) <br />The application <br />form; (2) Exhibits A -S, A. • endum 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 />s Regular 112 Operation Reclamation Permit contains three major parts: (1) the application <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, ALL information requested below. <br />1. Anolicant/oDerator 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 (nit, mine or site name): Loloff Pit <br />3. Permitted acreage (new or existing site): 55.17 existing permitted acres <br />3.1 Change in acreage (+) 0 acres <br />3.2 Total acreage in Permit area 55.17 total acres <br />4. Fees: <br />4.1 New Application $2.696.00 application fee <br />4.2 New Quarry Application $3.342.00 quarry application <br />4.4 Amendment Fee $2,229.00 amendment fee <br />4.5 Conversion to 112 operation (set by statute) $2,696.00 conversion fee <br />5. Primary commoditie(s) to be mined: Sand Gravel SOI( <br />5.1 Incidental commoditie(s) to be mined: 1. - lbs/Tons/yr 2. / lbs/Tons/yr <br />3. / lbs/Tons/vr 4. / lbs/Tons/yr 5. / lbs/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 />