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~ D L~ <br />~ boo <br />CONSTRUCTION MATERIALS <br />LIMITED IMPACT (110) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />CHECK ONE: There is a File Number Already Assigned to this Operation <br />Permit # M -~ ; _ (Please reference the file number currently assigned to this operation) <br />New Application (Rule 1.4.5) Amendment Application (Rule 1.10) <br />Conversion Application (Rule 1.11) <br />Petmi[ # M - -~ (provide for Amendments and Conversions of existing permits) <br />The application for a Construction Materials Limited Impact (110) Operation Reclamation Permit contains three major parts: (1) the <br />application form; {2) Exhibits A-J, Exhibit L, Addendum 1, any sections of Exhibit 6.5 and Geotechnical Stability Exhibit, as required <br />by the Office, and outlined in Rules 6.1, 6.2, 6.3, 6.5, and 1.6.2(1)(b); and (3) the application fee. When you submit your application, be <br />sure to include one (]) complete siened and notarized ORIGINAL and one (1) copy of the completed application form, two (2) copies <br />of Exhibits A-J, Exhibit L, Addendum 1, and appropriate sections of 6.5 (Geotechnical Stability Exhibit), as required, and a check for <br />the application fee described under (4) below. Exhibits should NOT be bound or in a 3-ring binder; maps should be folded to 8 ]/2" X <br />1 1" 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, in the space provided, ALL information described below. <br />1. Anpiicant/operator or company name (name to be used on permit): Grand County Department of Road and Bridge <br />1.1 Type of organization (corporation, partnership, etc.): Local Government <br />2. Operation name (pit. mine or site name): South Fork Gravel Pit (Forest Service Documents may refer to <br />o a a a ms r i <br />3. Permitted acreage (new or existine site): s. s~ permitted acres <br />3.1 Change in acreage (+) acres <br />3.2 Total Acreage in PetTnit Area S • 57 acres <br />4. Fees: <br />4.1 New Application: 1 094.00 application fee <br />Amendment Fee (C.R.S. 34-32.5-125(II)): $719.00 application fee <br />4.2 Conversion Fee (from 110d to 110 $875.00 conversion fee (Rule 1.11.2(2)) <br />5. Primary commoditie(s) to be mined: class c Road Ease: c-6 Minus <br />5.1 Incidental commoditie(s) to be mined: 1. / Ibs/fons/vr 2. / 16srI'ons/vr 3. / Ibs/Tons/vr <br />M/A 4. / Ibs/Tons/vr 5. / Ibs/Tons/vr <br /><ti <br />5.2 Anticipated end use of primary commoditie(s) to be mined: Road resurfacing ~ <br />t <br />Anticipated end use of incidental commoditie(s) to be mined: l ~ ' \t <br />2~ <br />