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DIVISION OF RECLAMATION, MINING AND <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 />@ 00 PID ly <br />Moe <br />FATE <br />OF COLORADO <br />✓ Complied! <br />✓2 Violations, <br />RECEIVED <br />MV -2016-019 <br />MV -2015-050 <br />i <br />MAR 082017 <br />COLORADO <br />Div 151 ON Of <br />RECLAMATION <br />DMRECLAMATION <br />MINING SAFELY <br />MIN&NG <br />SAFETY <br />CONSTRUCTION MATERIALS <br />REGULAR (112) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />c�,V4s♦ <br />MAR 0 <br />CF 1 <br />CIJECK ONE: There is a File Number Already Assigned to this Operation r`vI MN pFRE 0>> <br />Permit # M _131L` T (Please reference the file number currently assigned to this operation�Gdi/oN <br />ILNew Application (Rule 1.4.5) a Amendment Application (Rule 1.10) <br />aConversion Application (Rule LI l) <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 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 />8 112" 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 cam an name name to be used on iRerinitl: Washington County <br />1.1 Type of organization (corporation, partnership, etc.): GDvernment <br />2. Operation name fait, mine or site namel: Brick Pit <br />3. Permitted acreage (new 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 <br />Clay Sand <br />51.7 permitted acres <br />231.2 acres <br />282.9 acres <br />$2.696.00 application fee <br />$3,342.00 quant' application <br />$2.229.00 amendment fee <br />$2.696.00 conversion fee <br />5.1 Incidental commoditic(s) to be mined: 1. lbs/Tons/v2. / lbs/Tons/yr <br />3. / 1bs/Tons/vr 4. / Ibsifons/yr 5. I —lbs/Tons/yr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: Road surfacing <br />5.3 Anticipated end use of incidental commoditic(s) to be mined: Fill dirt <br />