2018-03-08_PERMIT FILE - M2018010 ‎(4)‎

• Permit No: M2018010
• IBM Index Class Name: PERMIT FILE
• Doc Date: 3/8/2018
• Doc Name: Application
• From: Fremont County
• To: DRMS
• Email Name: TC1
• Email Name: WHE
• Media Type: D
• Archive: No

STATE OF COLORADO
DIVISION OF RECLAMATION,MINING AND SAFETY
Department of Natural Resources
Den Sherman St.,Room 215 Permit #
Denver,Colorado 80203 r, ;Io- PT
C O L O R A D O
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■ DIVISION OF
Phone:[phone] �`` RECLAMATION
FAX:[phone] M-2018-010 ' ' , MINING
F tc I, whe SAFETY
CONSTRUCTION MA I EKi.At o
LIMITED IMPACT(110)OPERATION
RECLAMATION PERMIT APPLICATION FORM MAR 0 8 2018
DIVISION OF RECLAMATION
CHECK ONE: There is a File Number Already Assigned to this Operation MINING AND SAFETY
Permit# M - - (Please reference the file number currently assigned to this operation)
✓ New Application(Rule 1.4.5) Amendment Application(Rule 1.10)
Conversion Application(Rule 1.11)
Permit# M - - - (provide for Amendments and Conversions of existing permits)
The application for a Construction Materials Limited Impact(110) Operation Reclamation Permit contains three major parts: (1)the
application form;(2)Exhibits A-J,Exhibit L,Addendum 1,any sections of Exhibit 6.5 and Geotechnical Stability Exhibit,as required by
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
to include one (1)complete signed and notarized ORIGINAL and one(1) copy of the completed application form,two (2) copies of
Exhibits A-J, Exhibit L,Addendum 1,and appropriate sections of 6.5 (Geotechnical Stability Exhibit),as required,and�l check for the
application fee described under(4)below. Exhibits should NOT be bound or in a 3-ring binder;maps should be folded to'�1/2"X I I"or 8
1/2"X 14"size. To expedite processing,please provide the information in the format and order described in this form.
GENERAL OPERATION INFORMATION
Type or print clearly,in the space provided, ALL information described below.
1. Applicant/operator or company name(name to be used on permit): Fremont County
1.1 Type of organization(corporation,partnership,etc.):
2. Operation name(pit,mine or site name): SH 69 Gravel Pit
3. Permitted acreage(new or existintr site): 8.269 permitted acres
3.1 Change in acreage(+) acres
3.2 Total Acreage in Permit Area 8.269 acres
4. Fees:
4.1 New Application: $1258.00 application fee
Amendment Fee(C.R.S.34-32.5-125(II)): _$ application fee
5. Primary commoditie(s)to be mined: Gravel
5.1 Incidental commoditie(s)to be mined: 1. 11,1110/YR lbs/Tons/vr 2. / lbs/Tons/vr 3. / lbs/Tons/yr
4. ! lbs/Tons/yr 5. { Ibs/Tons/yr
5.2 Anticipated end use of primary commoditie(s)to be mined: Road Material
Anticipated end use of incidental commoditie(s)to be mined: N/A