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STATE OF COLORADO <br /> DIVISION OF RECLAMATION, MINING AND SAFETY <br /> Department of Natural Resources RECEIVED <br /> 1313 Sherman St.,Room 215 <br /> Denver,Colorado 80203 FEB COL O R A D O <br /> Phone:(303)866-3567 2019 RECLAMATION <br /> FAX:(303)832-8106 MINING <br /> LINCOLN COt,'NTY SAFETY <br /> CLERK&RECORDER <br /> CONSTRUCTION MATERIALS twi <br /> REGULAR(112)OPERATION JJJJ <br /> RECLAMATION PERMIT APPLICATION FORM RECEIVED <br /> CHECK ONE:�_ There is a File Number Already Assigned to this Operation APR 12 2019 <br /> Permit# M - ;' ( a3-_ (Please reference the file number currently assigned to this operation) <br /> MNew Application(Rule 1.4.5) M Amendment Application(Rule 1.10) LINCOLN COUNTY <br /> Conversion Application(Rule 1.11) CLERK&RECORDER <br /> Permit# M (`}3 - (provide for Amendments and Conversions of existing permits) Lad <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 1/2"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 company name(name to be used on permit): ._1 C.N.v rJ`r�L N 7f1 <br /> 1.1 Type of organization(corporation,partnership,etc.): N1;i 11 i3 �M i L� A R i�.S 5 fd 1 r LC LTA <br /> 2. Operation name(pit,mine or site name): <br /> 3. Permitted acreage(new or existine site): �" permitted acres <br /> 3.1 Change in acreage(+) 1 ��. acres <br /> 3.2 Total acreage in Permit area �G 5 acres <br /> 4. Fees: <br /> 4.1 New Application $2,696.00 application fee <br /> 4.2 New Quarry Application $3,342.00 quarry application <br /> 4.4 Amendment Fee $2,229.00 amendment fee <br /> 4.5 Conversion to 112 operation(set by statute) $2,696.00 conversion fee <br /> 5. Primary commoditie(s)to be mined: <br /> 5.1 Incidental commoditie(s)to be mined: 1. NCti�—:7 Ibs/Tons/yr 2. / lbs/Tons/yr <br /> 3. / lbs/I'ons/yr 4. / lbs/Tons/yr 5. / lbs/Tons/yr <br /> 5.2 Anticipated end use of primary commoditie(s)to be mined: <br /> 5.3 Anticipated end use of incidental commoditie(s)to be mined: �� <br />