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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 D O L Oi o N o� <br /> Phone:(303)866-3567 q RECLAMATION <br /> FAX:(303)832-8106 ��R � � �Q��" M I N I N G <br /> D1VI�ION OA��TYLMIN�RwNS <br /> SAF ETY <br /> INI�G � <br /> CONSTRUCTION MAT�ALS <br /> REGULAR(112)OPERATION <br /> RECLAMATION PERMTI'APPLICATION FORM <br /> CHECK ONE:� There is a File Number Already Assigned to this Operation <br /> Pernut# M - �� ����-� (Please reference the file number currently assigned to this operation) <br /> �New Application(Rule 1.4.5) �Amendment Application(Rule 110) <br /> �Conversion Application(Rule 1.11) <br /> Permit# M - 1'°f�'1 - Z � - (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 sianed 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 informarion 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. Aaalicandouerator or companv name(name to be used on nermit): �11. •--�,' �`► z'� � _ ��` r <br /> 11 Type of organization(corporation,partnership,etc.): _i �� �-. .� � =��' <br /> 2. Ooeration name(pit,mine or site name): ��E=<� 1 ��'�i ��� � <br /> 3. Permitted acreaQe(new or existing site): ��� permitted acres <br /> 3.1 Change in acreage(+) � lt ( acres <br /> 3.2 Total acreage in Permit area Z� acres <br /> 4. Fees: <br /> 4.1 New Application $2.696.00 application fee <br /> 4.2 New Quarry Application $3342.00 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: �-- � �`�y {�"� �'i�1�� �-t���c,`4' � <br /> 51 Incidental commoditie(s)to be mined: 1. �'��•�� 1bsJTons/yr 2. / Ibs/Tons/vr <br /> 3. / lbs/Tons/vr 4. / lbs/Tons/vr 5. / lbs/Tons/vr <br /> 52 Anticipated end use of primary commoditie(s)to be mined: �,�s�+���t���' �������.r'�c� � <br /> 53 Anticipated end use of incidental commoditie(s)to be mined: <br />