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STATE OF COLORADO <br />DIVISION OF RECLAMATION, MINING AND SAFETY <br />Department of Naturar Resources <br />RECEIVED <br />1313 Sherman St., Room 215 <br />COLO RA D O <br />Denver, Colorado 00203 <br />o 1 v r s r a N OF <br />Phone (303) 800-3567 <br />i �O�Q <br />NOVI9Vr 1 <br />RECLAMATION <br />FAX: (303) 832-8108 <br />U <br />MINING <br />DIVISION OF RECLAMATION <br />SAFETY <br />MINING & SAFETY <br />i <br />CONSTRUCTION <br />M _2O �O719 <br />REGULAR OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />CHECK ONE: 0— There is a File Number Already Assigned to this Operation <br />Permit # M (Please reference the file number currently assigned to this operation) <br />New Application (Rule 1.4.5) El— Amendment Application (Rule 1.10) <br />Conversion Application (Rule 1.11) <br />Permit # M - (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 I, 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 />8 112" X 1 l" or 8 112" 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 />I. Applicant/onerator or company name (name to be used on Permit): Parkerson Construction, Inc <br />1.1 Type oforganization (corporation, partnership, etc.): Corporation <br />F1 <br />Operation name (Pit, mine or site name): C Road Pit <br />3. Permitted acreaee fnew or existine site): <br />3.1 Change in acreage (+) <br />3.2 Total acreage in Permit area <br />4. Fees: <br />4.1 New Application <br />4.2 New Quarry Application <br />4.4 Amendment Fee <br />4.5 Conversion to 112 operation (set by statute) <br />5. Primary commoditie(s) to be mined: Gravel Sand Dirt <br />5.1 Incidental commoditie(s) to be mined: 1. lbs/Tons/vr <br />S�[• 9 permitted acres <br />acres <br />acres <br />$2.696.00 application fee <br />$3.342.00 quant' application <br />$2.229.00 amendment fee <br />52.696.00 conversion Fee <br />Cobble <br />2. / lbs/Tons/yr <br />3. / lbs/Tons/yr 4. 1 _ _ —lbs/ -Ton, -&r 5. 1 lbsC ondlr <br />5.2 Anticipated end use of primary commodities) to be mined: Construction and landscaping materials <br />5.3 Anticipated end use of incidental commodide(s) to be mined: <br />