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TATE OF <br />COLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />Depanment of Narural Resources <br />1313 Sherman 57., Room 215 <br />Denver, Colorado 80203 <br />Phone: (303) 866.3567 <br />FAX: 1303) 832-8(06 <br />CONSTRIICTION MATERIALS <br />RSGIILAR (112) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />Roy Romer <br />Governor <br />lames 5. Lochhead <br />Executive Direcror <br />Michael 8. Long <br />Division DirKior <br />CHECK ONE: X New Application (Rule 1.4.5) <br />Amendment Application (Rule 1.10) <br />Conversion Application (Rule 1.11) <br />Permit # - -_ (provide for Amendments and Conversions of <br />existing permits) <br />The application for a Construction Materials Regular 112 Operation Reclamation Permit contains <br />three major parts: (1) the application form; (2) Exhibits A-S, Addendum 1, any sections of <br />Exhibit 6.5 (Geotechnical Stability Exhibit; and (3) the application fee. When you submit your <br />application, be sure to include one (1) complete sinned and notarized IVORY ORIGINAL and four (4) <br />copies of the completed I_ vory application form, five (5) copies of Exhibits A-S, Addendum 1, <br />appropriate sections of 6.5 (Geotechnical Stability Exhibit, and a check for the application fee <br />described under Section (4) below. Exhibits should NOT be bound or in a 3-ring binder; maps <br />should be folded to 8 1/2" X 11" or 8 1/2" X 14" size. To expedite processing, please provide <br />the information in the format and order described in this form. <br /> GENERAL OPERATION INFORMATION M ' Q a ~ I~I <br /> <br />--- <br />-- Type or print clearly, in the space provided, ALL information requested below. <br />-------------------------------------------------------------- <br />--- <br />--- <br />--- <br />------ <br />---- <br />1. A pplicant/operator or company name (name to be used oa - <br />- <br />- <br />-- <br />- <br />permit): <br /> Tony J. Beltramo & Sons, Inc <br /> 1 .1 Type of organization (corporation, partnership, etc.): Corporation <br /> 1 .2 I.R.S. Tax I.D. No. or Social Security Number: <br />2. O peration name (pit, mine or site name): C^^ar pit <br />3. Permitted acreage (new or existing site): 1.fi1) permitted acres <br /> 3 .1 Change in acreage (+ or -) acres <br /> 3 .2 Total acreage in Permit area acres <br />4. Fees- <br /> 4 .1 New Application 1 875.00 application fee <br /> 4 .2 New Quarry Application $2,3 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 />5. Prima ry commoditie(s) to be mined: Sand Gravel Other Construction Aggregate <br /> 5 .1 Incidental commoditie(s) to be mined: 1. lbs/Tons/vr <br /> 2. 7 lbs/Tons/yr 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: Highway Work <br /> 5 .3 Anticipated end use of incidental commoditie(s) to be mined: NA <br />~~CEIVEp ~~ <br />iJE L ~~~~ <br />1 / It Ali <br />Divig, DEPARTMENT OF <br />an o; h•,~Rara)s 1. c: Gc!Op/ RE OLJR~ CES <br />