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<br />G~ 226(0 <br />~ 21344.E <br />~>-ks~! <br />STATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />Department OI Natural Resources <br />1 313 Sherman 4.. Room 215 R E C E ~?f E D <br />Denver, Colorado D0203 <br />Phone: (3031 856 3567 CONSTRCICTION MATERIALS FEB Z O ?OOI <br />FAX. (303) 83_-8106 REGULAR (112) OPERATION <br />RECLAMATION PERMIT APPLICATION FORMOivision of Minerals and G <br />~~ ~ <br />DIVISION OFI <br />MINERALS <br />~~EOLOGY <br />°~ CLA MATION <br />MI NING•SAFETY <br />Bill Owens <br />Governor <br />CHECK ONE: _~ There is a File Number Already Assigned to this Operation <br />Grea E. Walther <br />Permit # M boa- o i? (Please reference the fde Dumber eutrently assigned to this operation) Execuove D~reclor <br />M¢hael B. Long <br />_~~ New Application (Rule 1.4.5) _ Amendment Application (Rule 1.10) Division Director <br />Conversion Application (Rule 1.11) <br />Permit # M -_ (provide for Amendments and Conversions of existing permits) <br />The application for a Conswctioa Materials Regular 112 Operation Reclamation Permit contains three major parts: (1) the application form; <br />(2) Exhibits A-S, Addendum 1, nay sections of Exhibit 6.5 (Gaotechnical Stability Exhrbih and (3) the application fee. When you submit your <br />application, be swe to include one (1) complete si®ed and notarized Ti'ORY ORIGINAL and fow (4) copies of the completed Ivy <br />application form, Gve (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 />3 1/2" X 1 l" or 8 I/2" X 14" size. To expedite processing. please provide the information in the formal and order described in this form. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, is the space provided, all information described below. <br />1. AoPGcant/ooerator or tromoanv name (Dame to be used o0 oermk): <br />Washington County Road and Bridge Department <br />1. l Type of organization (corporation, partnership, etc J: CotrgtY Govetzttttent <br />1.2 I.R.S. Tax I.D. No. or Social Security Number: # ~ Fed =, D- ~ 8')-(00008/1 <br />2. Operation Dame (nit, mine or site oamel: Shook Gravel Pit 1 <br />3. Permitted acreage (new or eiistine ske): 270 permitted acres <br />3. I Change in acreage (+) N/A acres <br />3.2 Total acreage in Permit area 270 acres <br />4. Fees: <br />4.1 New Application x $2.344.00 application fee <br />4.2 New Quarry Application $2,906.00 quam application <br />4.4 Amendment Fee $1.938.00 amendment fee <br />4.5 Conversion to I L2 operation (set by statute) $2,344.00 conversion fee <br />5. Primary commoditie(s) to be mined: .,ot ~AnFw <br />--~ re~ <br />5.1 Incidental commoditie(s) to be mined: I. / Ibs/TooshT 2. / lbs/1'oas/vr 3. / Ibs/Tons~r <br />4. r Ibs(fonslvr 5. ! 1bs/fonsWr <br />999 <br />5.2 Anticipated end use of primary commoditie(s) to be mined: rrv~d R brides construction & tnaintanCe. <br />5.3 Anticipated end use of incidental commoditie(s) [o be mined: toads 8 bridge construction & tilaintanCe. <br />