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STATE OF COLORADO <br /> DIVISION OF RECLAMATION,MINING AND SAFETY <br /> Department of Natural Resources 14 t = <br /> - ' COLORADO <br /> 1313 Sherman St.,Room 215 o t v i s 1 o N o f <br /> Denver,Colorado 80203 4 1 RECLAMATION <br /> Phone:(303)866-3567 2022 MAY ` 7 AM 111: 0 MINING <br /> FAX:(303)832-8106 SAFETY <br /> CONSTRUCTION MATERIALS <br /> REGULAR(112)OPERATION <br /> RECLAMATION PERMIT APPLICATION FORM <br /> CHECK ONE:E_ There is a File Number Already Assigned to this Operation <br /> P_rmit# M -_ 2 0 Q9—9$fi (Please reference the file number currently assigned to this operation) <br /> e <br /> New Application(Rule 1.4.5) L =t"—Amendment Application(Rule 1.10) <br /> Conversion Application(Rule I.11) <br /> Permit# M -2 0 0 9—0 8 6 _ (provide for Amendments and Conversions of existing permits) <br /> The application for a Construction Materials Regular 112 Operation Reclamation Per contains three major parts:(1)the application <br /> ty Exhibit;and <br /> form;(2)Exhibits A-S,Addendum 1,any sections of Exhibit 6.5(Geotechnical Stabili d one (1) copy of the the application fee. When you <br /> completed <br /> submit your application, be sure to include one (1) complete si o� Sehsof6(Creotehn�calStabilityExhibit,andacheckfor <br /> application form,two(2)copies of Exhibits A S,Addendum ,appropriate 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 81/2"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. Avyhcant/ouerator or comyanv name(name to be used on permit : <br /> 1.1 Type of organization(corporation,partnership,etc.):. Corp <br /> 2_ Onerat�om name(pit,mine or site navel: <br /> Pickerin Famil Pit <br /> 1 g g-Q_ permitted acres <br /> 3. Permitted acrea¢e(new or existin¢sitel: + 16.84 acres <br /> 3.1 Change in acreage(+) 3 6.7 acres <br /> 3.2 Total acreage in Permit area <br /> 4. Fees: $2 696.0 application fee <br /> 4.1 New Application $3 342.00 quarry application <br /> 4.2 New Quarry Application $2 229.00 amendment fee <br /> 4.4 Amendment Fee $2,696.00 conversion fee <br /> 4.5 Conversion to 112 operation(set by statute) <br /> 5. Primary commoditie sand gravel <br /> s)to be mined: -- / lbs/Tons/vr <br /> 5.1 incidental commoditie(s)to be mined: 1._ - lbs/Tons/vr 2• <br /> 3. / lbs/'Tons/yr <br /> 4. / lbs/Tons/yr 5. / lbs/Tons/vr <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 />