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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 <br />Phone: (303) 866-3567 <br />FAX: (303) 832-8106 <br />CONSTRUCTION MATERIALS <br />REGULAR (112) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />CHECK ONE: There is a File Number Already Assigned to this Operation <br />Permit # M - - - (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 ---(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 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): <br />1.1 Type of organization (corporation, partnership, etc.): <br />2.Operation name (pit, mine or site name): <br />3.Permitted acreage (new or existing site): permitted acres <br />3.1 Change in acreage (+) acres <br />3.2 Total acreage in Permit area 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. - lbs/Tons/yr 2. / lbs/Tons/yr <br />3. / lbs/Tons/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: