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STATE OF COLORADO <br />DIVISION OF RECLAMATION, MINING AND SAFETY <br />Department of Natural Resources REV EIVEn <br />1313 Sherman St., Room 215 {•, <br />Denver, Colorado 80203 <br />Phone: (303) 866-3567 <br />FAX: (303) 832-8106 <br />CN01 <br />f <br />CONSTRUCTION MATERIALS <br />SEP 181018 <br />REGULAR (112) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />CHECK ONE: F,/1L— There is a File Number Already Assigned to this Operation <br />i <br />COLORADO <br />V M S ION OF <br />RECLAMATION <br />MINING <br />SAFETY <br />Permit # 2A? QD3 (Please reference the file number currently assigned to this operation) <br />New Application (Rule 1.4.5) EJ— 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 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 I I" 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/operator er company name (name to be used on permit): Yevoli Cobblestone Inc. <br />1.1 Type of organization (corporation, partnership, etc.): Corporation <br />2. Operation name (pit. mine pr site name): Yevoli Cobblestone Pit <br />3. Permitted acreage (low 4r 4gistine site): <br />9.98 <br />permitted acres <br />3.1 <br />Change in acreage (+) <br />73.52 <br />acres <br />3.2 <br />Total acreage in Permit area <br />83.5 <br />acres <br />4. f=; <br />4.1 <br />New Application <br />52.696.00 <br />application fee <br />4.2 <br />New Quarry Application <br />$1,342.00 <br />quarry application <br />4.4 <br />Amendment Fee229, <br />S2. , OQ <br />amendment fee <br />4.5 <br />Conversion to 112 operation (set by statute) <br />$2,696.00 <br />conversion fee <br />5. Primary commodilie(s) to be mined: Sand gravel <br />5.1 <br />Incidental commoditie(s) to be mined: 1 10000 Its/Tons/yr <br />2 1 <br />sIT n r <br />3. / Ibs/Tonstyr 4. / <br />5. _ I <br />Ibs/Tonslvr <br />5.2 <br />Anticipated end use of primary commodities) to be mined: construction materials <br />5.3 <br />Anticipated end use of incidental commoditie(s) to be mined. __ <br />� a CA <br />1; <br />, <br />0% <br />