_PERMIT FILE - M1999083

• Permit No: M1999083
• IBM Index Class Name: Permit File
• Doc Name: CONSTRUCTION MATERIALS LIMITED IMPACT 110 OPERATION RECLAMATION PERMIT APPLICATION FORM
• Media Type: D
• Archive: No

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o SATE OF COLORADO
DIVISION OF MINERALS AND GEOLOGY
of
Department of Natural Resources
1 313 Sherman Room 215 PAID
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Denver,Coloradodo I`/c
80203 Q
Phone:[phone] r
FAX.[phone] iU;. � ` 10C .
DEPARTMENT OF
Division of Minerals&Geology NATLJRAL
CONSTRUCTION MATERIALS RESOURCES
Roy Romer
LIMITED IMPACT (110) OPERATION Governor
RECLAMATION PERMIT APPLICATION FORM lames S.Lochhead
Executive Director
Michael B.Long
Division Director
CHECK 4NE: Yes_ New Application (Rule 1.4) Amendment Application (C.R.S. 34-32.5-110)
Conversion Application (Rule 1 .11)
Permit # - (provide for Amendments and Conversions of
existing permits)
The application for a Construction Materials Limited Impact (110) Operation Reclamation Permit
contains three major parts: (1) the application form; (2) Exhibits A-J, Exhibit L, Addendum 1,
any sections of Exhibit 6. 5 and Geotechnical Stability Exhibit, as required by the Office, and
outlined in Rules 6 . 1, 6 .2, 6. 3, 6. 5, and 1 . 6.2 (1) (b) ; and (3) the application fee. When you
submit your application, be sure to include one (1) complete' sioned and notarized IVORY ORIGINAL
and one (1) copy of the completed Ivory application form, two (2 ) copies of Exhibits A-J,
Exhibit L, Addendum 1, and appropriate sections of 6 .5 (Geotechnical Stability Exhibit) , as
required, and a check for the application fee described under (4) below. Exhibits should NOT be
bound or in a 3-ring binder; maps should be folded to 8 1/2" X 11" or 8 1/2" X 14" size. To
expedite processing, please provide the information at and order described in this
form.
m-9a=�3=====_
GENERAL OPERATION INFORMATION
Type or print clearly, in the space provided, ALL information described below.
-----------------------------------
1. Applicant/operator or company name (name to be used on permit) :
Cheyenne
1.1 Type of organization (corporation, partnership, etc. ) : _ CountV Government
1 .2 I.R.S. Tax ID No. or Social Security Number: 84-6000-750
2 . Operation name (pit, mine or site name) : Rothei Pit No. 1
3 . Permitted acreage (new or existing site) : 5.E5 permitted acres
3.1 Change in acreage (+ or -) 0 acres
Total Acreage in Permit Area 9.85 acres
4. Fees:
4. 1 New Application $875.00 application fee
Amendment Fee (C.R.S. 34-32 .5-125 (II) ) $575.00 application fee
4.2 Conversion Fee (from 110d to 110 87$ 5 .00 conversion fee (Rule 1.11.2 (2) )
5. Primary commoditie(s) to be mined: Gravel '
5.1 Incidental commoditie(s) to be mined: 1. r,�a - lbs/Tons/yr
2 . n/a / lbs/Tons/vr 3 . n/a / lbs/Tons/yr
4 . n/a / lbs/Tons/vr 5. n/a / lbs/Tons/vr
5.2 Anticipated end use of primary commoditie(s) to be mined: Road Maintenance
5.3 Anticipated end use of incidental commoditie(s) to be mined: n/a