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~ III IIIIIIIIII'lllll <br />~Tt~TE OF COLORADO <br />^1 VISION OF MINERALS AND GE040GY <br />Department of Naniwl Resources R ~~/_! <br />1 31.1 Sherman St., Room ? 15 • ' ~- t1 "~ e e +~® DIVISION O F <br />Denver. Cularndo H0203 ' <br />Ht,nne: ao31 Hea-~sfi; ~~t~ ~ M [ N &RA L 5 <br />Fnx:t_soilHi~-aloe ~ ~ c ••,r~ <br />v !-. J <br />,I~ GEOLOGY <br />O~~ Division of Minerals andGeolo MENINGMSAFET7 <br />~'~ CONSTRUCTION MATERIALS gy ~ <br />REGULAR (112) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM sill Owens <br />Governor <br />Creg E. Walther <br />Executive Director <br />CHECK ONE: ', ~ New A lication Rule 1.4.5 _ Amendment A lication Rule L10`v'icnael s. Eons <br />PP ( ) PP ( Division Director <br />Conversion Application (Rule l.] l) <br />Permit # M -~_- I (~ -_ (provide for Amendments and Conversions of existing permits) <br />The application for a Construction Materials Regular 112 Operation Reclamation Permit contains three major parts: (l) the application form; <br />(2) Exhibits A-S, Addendum 1, any sections of Exhibit 6.5 (Geotechnical Stability Exhibit; and (3) the application fee. When you submit your <br />application, be sure to include one (1) complete siPned and notarized IVORY ORIGINAL and four (4) copies of the completed Ivory <br />application form, five (5) copies of Exhibits A-S, Addendum 1, appropriate sections of 6.5 (Geotechnical Stability Exhibit, and a check for <br />the application fee described under Section (4) below. Exhibits should NOT be bound or in a 3-ring binder; maps should be folded to <br />8 1/2" X 11" or 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 <br />Type or print clearly, io the space provided, ALL iuformation requested below. <br />I. Aoalicant/ooerator or corooanv name (uame to be used ou permit): ~9i/7~/1/e.9.t9 <ottr/l~~F Afi1~ <br />G/L¢~L LL C. <br />1.1 Type oforganization(corporation, partnership, etc.):1.:.,.iTr» t..o~L.~~ orA~e.y <br />1.2 I.R.S. Tax I.D. No. or Social Security Number: 19 y -- / 3~ .~'J lv G <br />2. Operation name (pit. mine or site Hamel: Spa l~oK.~S (lA.UGN wGIT G/IRl~.~ iT <br />3. Permitted acreage (new or existine site): <br />3.1 Change in acreage (+) <br />3.2 Total acreage in Permit area <br />4. Fees: <br />4.1 New Application <br />4.2 New Quarry Application <br />4.3 Milling Application (Non-DMO) <br />4.4 Amendment Fee <br />4.5 Conversion [0 112 operation (set by statute) <br />5. Primary commoditie(sl to be mined: ~ .T 2tf19f ~T~~2//1 L <br />permitted acres <br /> acres <br />S7 acres <br />$1.875.00 application fee <br />$2,325.00 quarry application <br />$3.100.00 milling application <br />$1.550.00 amendment fee <br />$1.875.00 conversion fee <br />S.l Incidental commoditie(s) to be mined: 1. ,~.Q - Ibs/Cons/~ 2 / Ibs/I'ons/vr <br />3. / Ibs/i'ons/vr 4. / Ibs/Tons/vr 5. / Ibs/Tonslvr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: tii7 i /L~~yO'D ~A.f~ A/~ _ <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: - N~i.Q' <br />