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. _CTATr OFCOLORADO <br /> D!V!SlON Of MiNERALSAND GEOLOGY Ill ll�l <br /> Department of Natural Resources 899 <br /> 1313 Sherman St..Room 215 <br /> Denver.Colorado W203 o I v t s t O N o r <br /> Phone:(303)066-3567 E, MINERALS <br /> FAX:(303)832-8106 <br /> CF,VEp GEOLOGY <br /> SEp 8 R MINING•SAfETYECLAMATION <br /> CONSTRUCTION MATERIALS Division err)Owens <br /> REGULAR U 12)OPERATION of Minerals and Geology GOYer`os <br /> r <br /> RECLAMATION PERMIT APPLICATION FORM Gres E.Watcbet <br /> Executive Director <br /> With*B.Long <br /> Division Director <br /> CHECK ONE: _X New Application(Rule 1.4.3) Amendment Application(Rule 1.10) <br /> Conversion Application(Rule 1.11) <br /> Permit# _M - 220 _. (provide for Amendments and Conversions of existing permits) <br /> The application for a Cousttuction Materials Regular 112 Operation Reclamation Permit contains tbree major parts:(1)the application form: <br /> (2)Exhibits A-S,Addendum 1,any sections of Exhibit 6.3(Geotechnical Stability Exhbit;and(3)the application fee. Wban you submit your <br /> application,be sure to include one(1)complete sinned and nohriaod IVORY ORIGINAL and four(4)copies of the completed jvgv <br /> application form,five(3)copies of Exhibits A-S,Addadam,1,appropriate sections of 6.3(Gootochaical Stability F,xlubit,and a check for <br /> The application fee described under Section(4)below. F.xbubits should Eff be bound or in a 3-ring binder,maps should be folded to <br /> 8 U2"X 1 i"or 81/2"X 14"size To expedite processing,phase provide the information in the format and or-=described in this form. <br /> I <br /> GENERAL OPERATION INFORMATION <br /> Type or print clearly,to the space provided,all 1nformadon deaertbed below. <br /> 1. Aonikantlmmor or eomoanv name(gM to be used on nermlt): Roa 1119 FOrk R680=088 <br /> 1.1 Type of oration(corporation,partnership,etc.): Corwration <br /> 1.2 LILS.Tax 1D.No.or Social Security Number: 64-1163944 <br /> 2. O : Ma>.m Creek Saud & Gravel Pit <br /> 3. meted ggM faew or exiatlna eke): 08. 6 permitted acres <br /> 3.1 Change in acreage(+) acres <br /> 3.2 Total acreage in Permit area M•36 =ea <br /> 4. fgj: <br /> 4.1 New Application S2344.00 application fee <br /> 4.2 New Quarry Application S2,906.QQ quarry application <br /> 4.4 Amendment Fee ,SI S38.00 amendment fee <br /> 4.3 Conversion to 112 operation(set by statute) S2,344,QL conversion fee <br /> S. Pdmary commodkk(a)to be mined: Sand Gravel <br /> 3.1 IncideoW cotmmoditie(s)to be mined: 1. NIA/ _ lkae shz 2. L_ W 3. 1 lha(fons& <br /> 4. L nwroasNr 3. I tbs/roaalWr <br /> 3.2 Anticipated cad naa o(primary oommodh*z)to be mined: Constmetion <br /> 5.3 AnticipaW end also otiseidental commodi<ieW to bra mined; A . <br />