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STATE OF COLORADO <br /> DIVISION OF RECLAMATION,MINING AND SAFETY <br /> Department of Natural Resources R�� r� <br /> 1313 Sherman St.,Room 215 E® <br /> Denver,Colorado 80203 D C O L O A DO <br /> MR <br /> Phone:(303)866-3567 DIV I S I O N r <br /> FAX:(303)832-8106 V�l D RECLAMATION <br /> 1Q2 1S0 C <br /> F <br /> MININGANDS4F�,ON SA ETY <br /> MATERIALS <br /> LIMITED IMPACT(110)OPERATION <br /> RECLAMATION PERMIT APPLICATION FORM <br /> CHECK ONE: 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) 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 Limited Impact(110) Operation Reclamation Permit contains three major parts: (1)the <br /> application form;(2)Exhibits A-7,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-7,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 81/2"X 1 l"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. Aimlicant/operator or company name(name to be used on permit): Serfer Land Ventures, LLC <br /> 1.1 Type of organization(corporation,partnership,etc.): Limited Liability Company <br /> 2. Operation name(pit,mine or site name): Harmony Windsor Site <br /> 3. Permitted acreage(new or existing site): 9.9 permitted acres <br /> 3.1 Change in acreage(+) 0 acres <br /> 3.2 Total Acreage in Permit Area 9.9 acres <br /> 4. Fees: . <br /> 4.1 New Application: �Sablm 11�1 1258.00 application fee <br /> Amendment Fee(C.R.S.34-32.5-125(11)): --� 827.00 application fee <br /> 5. Primary commoditie(s)to be mined: sand gravel <br /> 5.1 Incidental commoditie(s)to be mined: 1. n/a / lbs/Tons/yr 2. / lbs/Tons/w 3. / Ibs/Tons/vr <br /> 4. / lbs/Tons/yr 5. / lbs/Tons/yr <br /> 5.2 Anticipated end use of primary commoditie(s)to be mined: Construction Materials <br /> Anticipated end use of incidental commoditie(s)to be mined: n/a <br />