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~o ~ urn ~`~1D~ -a~ ~T~TE OF C~LL~:I~.DC) <br />DtYfAON Of RECtAMAflON, ,MINING AND SAFEiY <br />Department of Natural Resoortes ~~ <br />1313 Shenn:m 5t., Room 215 <br />Denver, Colorado 80203 C O L O R A D O <br />UtVIltON OF <br />rltatlt (303'1666-3567 CONSTRUCTION MATERIALS RECLAMATION <br />FAX: 13031832-8106 REGULAR (Il Z) OPERAT{ON M t N [ NG <br />-&- <br />RECLAMdTION PER131T APPLICATION FORM SAFETY <br />sa; o„,~. <br />cup<mar <br />CHECK ONE: There is a Fite Number Already Assigned m this Operation <br />Ruvell feMge <br />Perrrrit # ~-_ ! _~ (Please reference the fife nttmber currently assigned to this operafiSft}7iVe o"eLtO` <br />Ronald w. C11tary <br />_ iVew Application (Auk 1.4,5j ~ Atntmdtnegt Application (Rule 1.10) Dnhion wraMr <br />Coavetsion Application (Ride 1.1 1) "a""ai RpiO1fC~ t"14"r <br />Permit # ~~i -_ -____ (provide for Amendmeats a~ Conversions of existing permits) <br />The application for a Constntction Ma[etials Regular 1 l2 Operation Reclamation Perrrdt contains three major pans: (1) the application <br />f1~ (2) Exhibsts A-S, Addendum 1, any sections of Exhibit 65 (Geottxhnical Stabih'ty Exhibit: and (3) the application fee. When you <br />submit your applicatioq be sta~e to inchrdc one (1) SAilplei< sited and notarized ORIGINAL and one (1) copy of the compk~d <br />application form, two {2) copies ofF.xhtbits A-S, Addendum 1, appropriate sections of6.5 (Geotechnical Stability Exhibit, suds ettxk for <br />die application fce deacnbtd attder Section (4) below. fixhibits should NOT be boit~ or is a 3-rule binder; snaps sboukl be Coldod to <br />8 172" X l 1" or 8 1f2' X l4" sizt. 7'o expediee processing, please pmvide the iliformatian in the format and order deuzibed in this form <br />QENERAL OPERATION INFORMATION <br />Type or print clearly, io the space provided, ALI in[ormatiou requested blow. <br />1.1 , Type of orgartizatuon (corporation, partnership, etc,}: <br />2. Ooeratlon came (nit mine or site Hamel: <br />3. Perm itted aceage mew or a:istl~ site): <br />3.1 C;ltarige in acreage (+) <br />3.2 Total acreage in Permit arts <br />4. I''ccs: <br />d,l NewApplicetion <br />4.2 New Quarry Application <br />4.4 Attietadmem Fee <br />4.S Conversioq to I 1 Z Operation (set by staana) <br />5. Primate eonmtoditiNsl to be mined: ~~,'~-_~- <br />5: S Incidental conunoditit(sj to be tnitxd: 1. ___ <br />3. _ 1 _ ibslfonsJvr A, <br />?.2 Anticipated end use of prirrury cotmnoditic(s) to be ^drted: <br />5.3 Anticipated end use of incideenal cotmnedttie(sj fo be mined: <br />O#ice of <br />.Mined latRl Reclamation <br />~?~.~ ~ o <br />pemtitttsi acres <br />_ acres <br />aoa~ acres <br />$2.341.00 application fee <br />32,906,00 quarry application <br />$1,438.Q0 arriendrnont fee <br />~~~~_~2 344A0 cnnvtrsion fee <br />inslyr 2. _ IbsiTonslyr <br />/IL4/4T S. lhs(fo~ <br />~T,~y~Tiu/v-~ !~ <br />Office of <br />Active and Inactive Mines <br />