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STATE OF COLORADO <br /> DIVISION OF RECLAMATION, MINING AND SAFETY <br /> Department of Natural Resources <br /> 1313 Sherman St.,Room 215 <br /> Denver,Colorado 80203 C O L O I ON OF 1 R A D O <br /> Phone:(303)866-3567 RECLAMATION <br /> FAX:(303)_832-810 . MINING <br /> RECEIVED SAFETY <br /> SCR 1 (t Z019 CONSTRUCTION MATERIALS RE <br /> DMSION OF RECLAMAT" LIMITED IMPACT(110)OPERATION <br /> MINING ANDSAFEIy SEP 17 2019 <br /> RECLAMATION PERMIT APPLICATION FORM <br /> DMSION OF RECLAMATION <br /> MINING AND SAFETY <br /> CHECK ONE: Z There is a File Number Already Assigned to this Operation <br /> Permit# M - M2019-049 (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 - - M2019-049 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(l)(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 11"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): Washington County- Dist 2 <br /> 1.1 Type of organization(corporation,partnership,etc.): Chris Aageson Pit#2 Addition <br /> 2. Operation name(pit,mine or site name): Chris Aageson Pit#2 Addition <br /> 3. Permitted acreaze(new or existine site): 1.17 permitted acres <br /> 3.1 Change in acreage(+) 0.0 acres <br /> 3.2 Total Acreage in Permit Area 1.17 acres <br /> 4. Fees: <br /> 4.1 New Application: $1258.00 application fee <br /> Amendment Fee(C.R.S.34-32.5-125(II)): $827.00 application fee <br /> 5. Primary commoditie(s)to be mined: gravel <br /> 5.1 Incidental commoditie(s)to be mined: 1. / lbs/Tons/yr 2. / lbs/Tons/yr 3. / lbs/Tons/vr <br /> 4. / lbs/Tons/vr 5. / Ibs/Tons/yr <br /> 5.2 Anticipated end use of primary commoditie(s)to be mined: road cover <br /> Anticipated end use of incidental commoditie(s)to be mined: <br />