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<br />iii iiiiiiiini~~ iii <br />STATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />DeUUnmenl of Nalunil Kesnurces <br />1 31 S Shcrm,rn St . Knom 215 <br />Denver, GJnmdu N(11U1 <br />Phono. 110 4 Bb L~ 1 ih? <br />t.nx~. t la~l n 12~a uu, <br />P.2~. 1t u ~ 3 ~ <br />U~ ~ IOo 3 <br />- -r`- l <br />-~~1: <br />~-'~I <br />r~I <br />1 <br />DEPARTMENT OF <br />NATURAL I <br />RESOURCES <br />ui; I ~ 1 195 <br />CONSTRUCTION MATERIALS <br />REGULAR OPERATION (112) <br />RECLAMATION PERHIT APPLICATION FORM ~`~~`'C~`~ <br />Roy Ronicr <br />Go. ernor <br />lames 5. Lochhead <br />E.ecuuve Oveao, <br />nuchael B. Lone <br />D wisiun OrteOU~ <br />CHECK ONE: XX New Application (Rule 1.4.5) Amendment Application (Rule 1.10) <br />Conversion Application (Rule 1.11) <br />Permit / M - 97 -______-, (provide for Amendments and Conversions of <br />existing permits) <br />The application for a Regular 112 Operation Reclamation Permit contains three major parts: (1) <br />the application form; (2) Exhibits A-S, Addendum 1, any sections of Exhibit 6.5 (Geotechnical <br />Stability Exhibit; and (3) the application fee. when you submit your application, be sure to <br />include one (1) complete signed and notarized IVORY ORIGINAL and four (4) copies of the completed <br />ivory application form, five (5) copies of Exhibits A-S; Addendum 1, appropriate sections of 6.5 <br />(Geotechnical Stability Exhibit, and a check for the application fee described under Section (4) <br />below. Exhibits should not be bound or in a 3-ring binder; maps should be folded to 8 1/2" X 11" <br />or 8 1/2" X 14•' size. To expedite processing, please provide the information (yJ'n the for at and <br />order described in this form. M_ l ~ - O 8 <br />GENERAL OPERATION INFORMATION <br />Type or print clearly in the space provided the information requested below. <br />1. Applicant/operator or company name (name to be used on permit): <br /> DAREN STONE <br /> 1.1 Type of organization (corporation,. partnership, etc.): SOLE PROPRIETORSHIP <br /> 1.2 I.R.S. Tax I.D. No. or Social Security Number: <br />2. operation name (pit, mine or site name): STONE GRAVEL PIT <br />3. Permitted acreage (new or existing site) 158.18 permitted acres <br /> 3.1 Change in acreage (+ or -) acres <br /> 3.2 Total acreage in Permit area 158.18 acres <br />4. Fees: <br />4.1 <br />New Application CHECK N~ ~ 0 0 3 --_~ att <br />ached: 51,875.00 application fee <br /> 4.2 New Quarry Application 52,325.00 quarry application <br /> 4.3 Milling Application (Non-DMO) _ 53,100.00 milling application <br /> 4.4 Amendment Fee 51,550.00 amendment fee <br /> 4.5 Conversion to 112 operation (set by statute) 51,875.00 conversion fee <br />. <br />5. Primary commoditie(s) to be mined: SANll 6 GRAVEL S <br /> 5.1 Incidental commoditie(s) to be mined: 1. BONROW _25, 000 ±t~/~~~/vr <br />' <br /> 2. / lbs/Tons/vr 3. / lbs/Tons/vr <br /> 4. / lbs/Tons/vr 5. / lbs/Tons/vr <br /> 5.2 Anticipated end use of primary commoditie(s) to be mined: AGGREGATE <br /> 5.3 Anticipated end use of incidental commoditie(s) to be mined: EPiBANKMENT <br />--1-- <br />