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III IIIIIIIIIIIII III ,P INJ�5 <br /> T.1,00F COLOMDO <br /> DIVISION MINERALS AND GEOLOGY <br /> 01 <br /> Department of Natural Resources <br /> 1313 Sherman St..Room,15 <br /> Denver.Colorado 80203 G.:r; ; . _.... cr�'ugq D I V I S I O N o 1- <br /> Phone:(3031866-3567 CONSTRUCTION MATERIALS M I N E RA L S <br /> FAX (303)632-8106 REGULAR(112)OPERATION & <br /> GEOLOGY <br /> RECLAMATION PERMIT APPLICATION FORM R E C L A M A T I O N <br /> MINING-SAFETY <br /> B&Owens <br /> Governor <br /> CI ECK ONE: There is a File Number Already Assigned to this Operation ereg E watcher <br /> Permit# M -)0-r- e 1!*r-_ (Please reference the file number currently assigned to this operation) E.ecuuve Duecror <br /> XX New Application(Rule 1.4.5) Application ) Michael B.Long <br /> Amendment A hcation(Rule 1.10 0���:.on D"ector <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 dime major parts:(1)the application form; <br /> (2)Exhibits A-S,Addendum 1,any sections of Exhibit 6.5 (Geotechnical Stability Exhibit;and(3)the application fee. When you submit your <br /> application, be sure to include one (1)complete signed and notarized IVORY ORIGINAL and four (4) copies of the completed Ivory <br /> application form.five(5)copies of Exhibits A-S.Addendum I,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 /> GENERA N INFORMATION <br /> Type or print clearly,in the space provided,all information described below. <br /> 1. Applicant/overator or company name(name to be used on permit): <br /> Hall -Irwin Corporation <br /> 1.1 Type of organization(corporation,partnership,etc.): Corporation <br /> 1.2 LRS. Tax I.D. No.or Social Security Number: 84-0524573 <br /> 2. Operation name(oit,mine or site name) North LaPoudre <br /> 3. Permitted acreage(pew or existing site): 38 permitted acres <br /> 3.1 Change in acreage(4) acres <br /> 3.2 Total acreage in Permit area 38 acres <br /> 4. Fees: <br /> 4.1 New Application $2,344.00 application fee <br /> 4 2 New Quarry Application $2.906.00 quarry application <br /> 4.4 Amendment Fee $1.938.00 amendment fee <br /> 4.5 Conversion to 112 operation(set by statute) $2,344.00 conversion fee <br /> 5. Primary commoditie(s)to be mined: gravel sand <br /> 5.1 Incidentalcommoditie(s)to be mined: 1. / Ibs/rousfyr 2. / lbs/Tons/vr 3. / Ibs/foas/vr <br /> 4. Ibs/Tons/yr 5. lbs/Tons/vr <br /> 5.2 Anticipated end use of primary commoditie(s)to be mined: construction materials <br /> 5.3 Anticipated end use of incidental commoditie(s)to be mined: <br />