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~ <br />~ I;oq~. 00 <br />STATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY RECE9oIED <br />Department of Natural Resources <br />1313 Sherman St., Room 215 <br />Denver, Colorado 80203 DIVISION O F <br />Phone: (303) 866-3167 OCT O ~ Zi~QZ / MINERAL S <br />FAX: (303; E32-8106 CONSTRUCTION NL9TERIALS & <br />Qirisian of Minerals and Gealo ~' E O L O G Y <br />LIMTTED 111IPACT (ISO) OPERATION E C L A M AT I O N <br />MINING•SAf ETY <br />FILE COPY RECLAMATIONPERlYIITAPPLICATIONFORM ~ <br />fOR SCANNING <br />C? ~~ CK OI~TE: Tlsere is a File Number Already Assigned to this Operation <br />Permit # M ~-_ (Please reference the file number currently assigned to this operation) <br />X New Application (Rule 1.4.5) <br />Conversion Application (Rule 1.11) <br />Amendment Application (Rule 1.10) <br />Bill Owens <br />Governor <br />Greg E Watcher <br />Executive Director <br />Ronald W. Cottony <br />,fining Division Director <br />Permit # M - _ (provide for Amendments and Conversions of existing permits) <br />The application for a Construction Materials Limited Impact (110) Operation Reclamation Permit contains three major parts: (1) the <br />application form; (2) Exhibits A-J, Exhibit L, Addendum 1, any sections of Exhibit 6.5 and Geotcehnical Stability Exhibit, as required by the <br />Office, and outlined in Rules 6.1, 6.2, 6.3, 6.5, and 1.6.2(1}(b); and (3) the applicafion fee. When you submit your application, be sure to <br />include one (1) complete signed and notarized IVORY ORIGINAL and one (1) copy of the completed Ivy application form, two (2) copies <br />of Exhbits A-J, Exltibit L, Addendum 1, and appropriate sections of 6.5 (Geoteclmical Stability Exhibit), as required, and a check for the <br />applhcatiDn fee described under (4) below. Exlbis should NOT be bound or in a 3-ring binder; maps should be folded to 8 112" X l 3 " or <br />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 /~/ p <br />Type or print clearly, in the space provided, ALL i~'ormation described below. r ! -Gi~Q~ ~ ~~O `/ <br />I. Aoolicantlooerator or comoanv name (name to be used on Hermit}: LINCOLN COUNTY / <br />1.1 Type of organization (corporation,pattnership,etc.): GOVERNMENT <br />1.2 I.RS. Tax ID No. or Social Security Number: 2.: <br />2. Operation name (nit. mine or site name): E I K E R MANN '~ <br />3. Permitted acreage (new or eaistine site): +ot- 9 . 5 permitted acres <br />3.1 Change in acreage (+) acres <br />3.2 Total Acreage in Pemtit Area acres <br />4. Fees: <br />4.1 New Application: $1.094.00 application fee <br />Amendment Fee (C.RS. 34-32.5-125(II)): $719.00 application fee <br />4.2 Conversion Fee (from 1104 to 110 875.00 conversion fee (Rule 1.11.2(2)) <br />5. Primarvcommoditie(s)tobemined: SAND GRAVEL <br />• 5.1 Incidental commoditie(s) to be mined: 1. NA/ 1bsJI'ons/vr 2. ! lbs/Tons/vr 3. / 1bs/Tons/vr <br />4. / lbs/Tons/vr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: <br />Anticipated end use of incidental commoditie(s) to be mined: <br />5. / Ibs/Tons/vr <br />ROAD MAINTENANCE <br />NA <br />