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M- oZoo7_ flb~ ~- <br />"" DIY151t7N Of RKIAMATION, MINING AND SAFETY / <br />Depa,t,nent of Natural Resources <br />1373 Sherman St., Room 215 <br />Denver, Colorado 80203 <br />Phone 13031 SGfr3567 <br />FAX: (3031 832-0t06 <br />-STATE OF COLORADO <br />e~ ~b"' ~~~ `~ <br />~~^~t COLORADO <br />CONSTRUCTION MATERIALS v /q 4 Q ~~ ~ At ~ o TION <br />REGULAR (112) OPERATION !v 2 j '7e[I IV TANG <br />~if/lSip <br />RECLAMATION PERMIT APPLICATION FO ~ of G ~ SAFETY <br />~J,if„f9 an~ Ja e ~o~_-_ <br />Covertwr <br />CFIECK ONE: Tdere is a File Number Already Assigned to this Operation <br />Russell Gxxge <br />Pemrit # 1~..'~-_ _ ~ (Please reference the file number cutrendy essigtled to this opera(.t~"e o""~0f <br />. Roam w. campy <br />New Application (Bole 1.4.5) f Amendmem Applicaton (Ruse 1.]D} oNhl"n olre~m <br />__ Conversion Application (Rule 1.11) Natural Rewurre Trusnx <br />Pertnit # ~_-~ -_ (provide for Amendments and Conversions of existing pemtits) <br />The application for a COOSnuction Materials Regular 1 l2 Operation Reclamation Pemrit contains three major pflrts: (I}the application <br />form; (2) Exhibits A-S, Addendum 1, any sections of Fachibit 6.5 (Geotechnical Stability Exhtbir, and (3) the application fee. When you <br />submit your application, be sure to iochtde one (1) co late signed and notarized ORIGINAL and one (1) cagy of the completed <br />application form, two (2) copies ofExhtbits A-S, Addenfilm 1, appropriate sections ofti.5 (Creutecbnical Sfablliry Exlnbit, ands check for <br />the application fee described uttder Sectiott (4}below. Exbibits shotsld NOT be bound ~ in a 3-ring bit~et; stmps shoukt be folded to <br />R 1/2" X 11" or 8 I!2" X 14" siu. To expedite processing, please provide thetde infomtation in the format and order described in this form <br />OENERAI.OPERATIONINFORMA <br />Type or print clearly,ln the space provided, ALL <br />1.1 Type of organization (cotpom6on, partttetship, etc.): <br />2. Oneratiaa oattte (tit. mine or site name): <br />3. )'grm itled aceage fsresr or esisHoa site): <br />3.I Change in atxeage (+) <br />3.2 Total acreage in Permit area <br />4. Foes: <br />4,1 New Application <br />4.2 New Quarry Application <br />4.4 Anwrodmem Fee <br />4.S Com~ersion to 112 operation (set by s <br />tap <br />n <br />e <br />) <br /> ~/ <br />~~ <br />/A <br />/// <br />/n <br />f/ <br />f( <br />~ <br />J) <br />5. Primary rnmmoditidsl to mined: ~>~ <br />S.I Incidental cotmnodirie(sj w be mined: 1. __ <br />3. ,,.__ / IbslTonsJvr 4. <br />5.2 Anticipated end use of primary cosmnoditie(s) to 6e mined: _ <br />5.3 Anticipated ettd ttse of incidental commoditie(s) to be ntirled: <br />~~ pemtitted acres <br />_ '~ acres <br />.;;z~...~a - actor <br />52.34100 application fee <br />S2,9o6.00 quarry application <br />51,93R.00 amendment fee <br />~~ .-2 3$ .44.00 conversion fee <br />~~ 2. / Ibsfl'onsWr <br />iR4/4T 5. ' Ibs/fonsi <br />(^ ~ <br />--- <br />requested hdow. <br />~~ <br />Office of Office of <br />Mined land Reclamation Active and inactive nAiaes <br />