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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 C O L O R A D O <br /> Denver,Colorado80203 DR <br /> a v i s a R n o re <br /> Phone (303)866-3567 RECLAMATION <br /> FAY.(303)832-8106 M i N I N G <br /> SAFETY <br /> CONSTRUCTION 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 4 M -_ (Please reference the file number currently assigned to tliis operation) <br /> qNew Application(Rtdc 1,4 5) Amendment Application(Rude 1.10) <br /> Conversion Application(Rule 111) <br /> Permit# %1 - - (provide for Amendments and Conversions of existing permits) <br /> The application for a Construction Materials Limited impact(110)Operation Reclamation Permit contains three major pans. (1)the <br /> applicuion form:(2)Exhibits A-J,Exhibit L,Addendum 1,am sections of Exhibit 6.5 and Gcotechnical Stability Exhibit,as required bN <br /> the Office,and outlined in Rules 6,I,6.2,6 3.6 5,and 16.2(1)(b):and(3)the application Ice When)ou submit}our application.be sure <br /> to include one(1)complete signed and notarized ORIGINAL and one(1)copy of the completed application form,mo(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(•I)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"sae. To expedite processing,pleasc provide the information in the fonnat 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): Tara Sanders <br /> 1 I T�pe of orgarum ion(corporation,partnership,etc.): Individual <br /> 2 Operation name(nit,mine or site name): Sanders Gravel Pit <br /> Permitted acreaee(new or evistine site): 9 95 permitted acres <br /> 3.I Change in acreage(+) U acres <br /> 2 "total Acreage inn Permit Area 9 95 acres <br /> d Fees. <br /> 4.t New Application: $1258 tro application fee <br /> Amendment Fee(C R.S.34-32.5-125(il)): $827,00 application fee <br /> 5 Priman commodities)to he mined. sand gravel <br /> 5 1 Incidental corunioditic(s)to be mined. 1. / lbs/Tons/%r 2, n/a / ibs/Tons/%'r 3. n1a r <br /> 4, n/a/ Ibst'Tons/vr 5. n/a / lbs(rons/N r <br /> Anticipated end use of prinu.•an commodrtie(s)to be mined. construction materials <br /> Anticipated end use of incidental commodune(s)to be mined' construction materials <br /> ) <br /> f <br /> t <br />