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~`~co ?~ ~~ ~~~; •a~ STATE ~F CQL~I~.L~C~ <br />DIYtSlOIV OF RKtAMATION, MtNlNG AND SAFETY <br />Deganmeni of Natural Resources <br />7373 Sherman St., Room 215 <br /> <br />Denver Colorado 80203 C O L O tlA D O <br /> <br />Peons: i3o3i 8663567 CONSTR(iCTION MATERIALS UiVI>ION OF <br />RECLAMATLON <br />F!J(: i303! 832 706 <br />REGU'I.AR 117 2) OPERATION M i N [ NG <br />, ~, _ <br />RECLAM1iATION PEILXIIT APPLICATION FORM <br />8d{ Owe^s <br />Goacrwr <br />CHECK ONE: There is a Fits Number Already Assigned to this Operation <br />Russell Getxp/~ <br />Pemrit # M -_-_ __ (Pleas reference the fife number currently assigned to this opera€fVe O1eCOr <br />Nett lirafion Rule I.4.5 Amendment A lication Rule 1.I0 Rormd K. C2nary <br />APp ( ) PP ( ) Onxsion ot,.~, <br />_^ COaversion Application (Rule 1.1 ]) nawr-+i ar_wnrce 7rosee <br />Permit # t~-^ -_ (provide for Amendments a~ Conversions of existing pemtitsj <br />The application for a Consnuedon Materials Regular 1 l2 Operation Reclamation Pertxdt contains three tnajor pans: (1 }the application <br />form; (2) Exhibits A-S, Adderrdmn 1, any sections of Exhibit 6S (Geotechrtical Stability Extubit; and (3) the application fee. When you <br />submit your application, be sure to itxhtde one (I) cortmistc sieved and notarized ORIGI.NAI. attd one (1} copy of fie completed <br />application forte, two (2) copies ofERl»bits A-S, Addendum 1, appropriate sections of 6.5 (Gcittechnirat Stability Exbibit, ands check For <br />the application fee desctibeti under Section (4) below. Exhibits should NOT be hotted or in a 3-ring binder; maps should be folded to <br />8 I!2° X i I" or 8 lY2° X 14" size. To expedite processing, pieaseprovide thet3te infortation in the fot~t and order described in this form. <br />GENERAI.OPERATION INFORMATION <br />Type or print clearly, in the space provided, AI.L information requested below. <br />1. ArtplieanUocerator or cotnpa~ttartae (Warne to be Deed on certtdtl: rA"C~13~ /'i~/1/~1~ _~_. _ ~ / / ~`U <br />1.1 , 'Cype of organiratuon (corporation, partnership, etc.): <br />2. Operation ttatne tttit. mine or site Hamel: <br />3. Permitted acreage (new or etcistive sites: <br />3.1 Change in acreage (i-) <br />3.2 Total acreage in Perrtut area <br />4. Foss: <br />4.1 New Application <br />43 New Quarry Application <br />4.4 Aatcndmenr pee <br />4.S Com'ersion to l 12 Operation (set by eta <br /> <br />5. Primate rnmmoditie(~, to be mipe~: <br />S.I Fncidrntal cornmoditie(sj to be mitred: L __ <br />3._~ ! lbslfons/vr 4. <br />5.2 Anticipated end use of printery cormnoditic(s) to be mitred: _ <br />S.3 Anticipated atd use of incidetnal contttteditie(s) to be mimd: <br />r~~ {, <br />t>'~ / t~ ' / ~ <br />~ --- <br />.~8 a _ Permitted acres <br /> acres <br /> ._ acres <br />$2.341.00 application fee <br />$2,906_00 quarry application <br />_~I,_93R~00 arrtendtrtent fee <br />~~~-$2.344-00. conversion fee <br />tns~ 2. __ IbslTons'tir <br />anslyT 5. <br />- Ibsrl'o>~ <br />_ <br />~~~l~~i(Tiuyi ~1~ - <br />Oflice n( Q(iice of <br />MineA feral Ra:lamation Active and Inactive Mines <br />