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TATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />Department of Natural Resources <br />t 373 Sherman 61, Room z, s C O L O RA D O <br />Denver, Colorado 80203 ~ D t v t s t O N o f <br />Phone: 1303) 8663567 CONSTRUCTION MATILRIA~ MINERAL S <br />FAX: (303) 832706 & <br />LIMITED T111PACT (110) OPERATION G E O L O G Y <br />RECLAMATION PF,RNIIT APPLICATION FORM <br />Bill ovens <br />Covemor <br />FIECK ONE: 17fcre is a File Number Already Assigned to this Operation eE ~e<,rt;.,e o ,ecw, <br />Permit # M -_-_ ~ (Please rd'erence the file number currently assigned to this operation) ~~ `N• may <br />Division DireROr <br />/New Application (Rule 1.4.5) Amendment Application (Rule 1.10) Natural aesource trustee <br />CoarcrsioaApplication(Rule 1.11)__ _~ _ _ __, - - <br />Permit # M -~ -_ (provide for Amendments and Conversions of existing permits) <br />he application for a Construction Materials Limited Impact (I 10) Operation Reclematirm Permitoontaiostbreemajorparts: (1)the application <br />rim; (2) Ex}ubits A-J, Exhibit L, Addendum ],any sections of Exhibit 6.5 and Geotechnical Stability Exbibi; as regt»red by the Office, and <br />uttined in Rules 6.1, 6.2, 6.3, 6.5, and 1.6.2(I)(b); and (3) the application fee. When you submit your application, be sure in include one <br />l) gomolete rigged and notarized NORY ORIGINAL and one (1) copy of the completed ]vor application fomt, two (2) copies ofExhtbits <br />.-J, E~ribit L, Addendum I, and appropriate sections of 6.5 (Geotecbnical Stability Exhibi[), as required, and a check for the application fee <br />esenbed under (4) below. Exhibits should NOT be bound or in a 3-ring bittdea-; maps should be folded to 812' X 11' m 81/2' X 14'size. <br />'o 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 described below <br />i. ADnl3caoUaperator or cmm~anvname (name to be used on permit]: ,~/ FU7F0 TO ~. ~/ Uf ~ /7` <br />I.I Type of organization (corporation, partnership, etc.): J`-_ o ~a -~ ~ij~iJ 2 / G,f6 !Z. <br />1.2 I.Z I.A.S. Tax ID No. or Socia[ Security Ntmtber:ri ,~ ~- 9G - 9D l <br />?. Operation name (Dit, mine or site name}; ~/ !/~- iZ Fl C ~L:(rF3 U%'?-ty0/f/ C~ ~ F• Uf< ~- ~~ i.. <br />3. Permitted acrcase (new or existinQsife}: ~_permitted acres <br />-3:1- Change is acreage.(+)_ - _ _ _ . acres <br />3.2 Total Acreage in Permit Area ~ - 9.S" acres <br />4. Fees <br />4.1 New Application: 1 094.00 application fee <br />Amendment Fee (C.F S. 34-32.5-12i(In): 7 9.00 application fee <br />4.2 Conversion Fee (Gom i l Od to 1 IO $875.00 tbnvetsion fee (Buie 1.21.2(2)) <br />5. Ptimarv commoditie(s) [n be mined: /6U <br />5.1 Incidental commoditie(s) to be mined: 1.~~OU') lbs n. 2. / ibs/foos/vr 3. / lbs/fonsl~ir <br />4. ! Ibs/I'onslvr 5. / IbsJf'ons/vr <br />S.Z Anticipated end Ise of primary commoditie(s) to be mitred: C~J/f 5 ~ ~? c/ ~^ 7`/!in/ "3' ~~h F/ I) .Y i r r :c~/.c f <br />r J <br />Anticipated end rse of incidental cotnmoditie(s} to be mined: /L/o~F <br />Offire of Office of Colorndo <br />ARive and Inactive Mines Geological Survey <br />