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CONSTRUCTION MATERIALS <br /> MAY 12 2005 <br /> LIMITED IMPACT(110)OPERATION �:Ll;1R. cf t. ::,�_ W <br /> RECLAMATION PERMIT APPLICATION FORM <br /> CHECK ONE: X-- There is a File Number ]ready Assigned to this Operation <br /> Permit 4_M. - 2000 -018 (Please reference the file number currently assigned to this operation) <br /> New Application(Rule 1.4.5) X Amendment Application(Rule 1.10) <br /> Conversion Application(Rule 1.1 I) <br /> Permit# M - 2000 - M 8 (provide for Amendments and Conversions of existing permits) <br /> The application for a Construction Materials Limited Impact(110)Operation Reclamation Permit contains three major parts: (1)the <br /> application form;(2)Exhibits A-J,Exhibit L,Addendum 1,any sections of Exhibit 6.5 and Geotechnical Stability Exhibit,as required by <br /> the Office,and outlined in Rules 6.1,6.2,6.3,6.5,and 1.6.2(1)(b);and(3)the application fee. When you submit your application,be sure <br /> to include one(1)complete signed and notarized ORIGINAL and one(1)copy of the completed application form,two(2)copies of <br /> Exhibits A-J,Exhibit L,Addendum 1,and appropriate sections of 6.5(Geotechnical Stability Exhibit),as required,and a check for the <br /> application fee described under(4)below. Exhibits should NOT be bound or in a 3-ring binder,maps should be folded to 8 1/2"X I I"or 8 <br /> 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 described below. <br /> 1. Applicant/operator or company name(name to be used on permit): Cheyenne County <br /> 1.1 Type of organization(corporation,partnership,etc.): County Government <br /> 1.2 I.R.S.Tax ID No.or Social Security Number. 84-6000-750 <br /> 2. Operation name pit,mine or site name): Munsch Pit <br /> 3. Permitted acreage(new or existine site): _7.5 permitted acres <br /> 3.1 Change in acreage(+) 2 acres <br /> 3.2 Total Acreage in Permit Area 9.5 acres <br /> 4. Fees: <br /> 4.1 New Application: $1,094.00 application fee <br /> Amendment Fee(C.R.S.34-32.5-125(11)): $719.00 application fee <br /> 4.2 Conversion Fee(from 110d to 110$875.00 conversion fee(Rule 1.1 L2(2)) <br /> 5. Primary commodities)to be mined: Sand Gravel <br /> 5.1 Incidental commoditie(s)to be mined: 1. / lbsrfop., 2._ / lbs/Tons/yr 3.— / Ibs/TonsJvr <br /> 4. IbsrTons/ 5. i Ibs/Tons/vr <br /> 5.2 Anticipated end use of primary commoditie(s)to be mined: Sand & Gravel to be spread on enty rds. <br /> Anticipated end use of incidental commoditie(s)to be mined: NIA <br />