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. Oi~~, <br />m - ao~~- v~3 <br />EIlE COPY <br />ROR SCANN/NG CREGULAR (11102) OPERATIONS ~ <br />RECLAMATION PERMIT APPLICATION FORM <br />CHECK ONE: There is a File Number Already Assigned to this Operation <br />RFC~~~~~ <br />S£P 3 0 2004 <br />OieisionotM/n L/ <br />e~alS and geology <br />Permit # M -_- _ (Please reference the file number currently assigned to this operation) <br />X New Application (Rule 1.4.5) Amendment Application (Rule 1.10) <br />-Conversion Application (Rule 1.11) <br />Permit # M - - - (provide for Amendments and Conversions of existing permits) <br />The application for a Construction Materials Regular 112 Operation Reclamation Permmitcontaigsthree gajor parts: (1) the applicatiop <br />form; (2) Exhibits A-S, Addendum 1, any sections of Exhibit 6.5 (Geotechnical Stability Exhibit; and (3) the application fee When you <br />submit your application, be sure to incl ude pne (1) cpmplete signed and notazized ORIGINAL and one (1) copy ofthe com pleted <br />application form two (2) espies of Exhibits A-S, Ad en , appropnate secttons o .5 eotec ical StabilityElchibit, and a check for <br />the application fee described under Section (4) below. Exhibits should NOT be bound or in a 3-ring binder; m fps should be folded tp <br />8 1/2 X 11" or 8 1/2" X 14" size. To expedite processing, phase provide the information in the format and order described in this form <br />I <br />Type or print clearly, in the spaceproyided, ALL information requested below. <br />1. Applicantloperator or company name (name to be used on permit) <br />1.1 Type of organization (corporation, paMership, etc.): <br />l.~ LRS. Tax LD. No. or Social Security Number: <br />2. Operation name (pit, mine or site name) <br />3. Permitted acreage (new or existing site) <br />3.1 Change in acreage (+) <br />3.2 Total acreage in Permit areq <br />4 Fees: <br />~~ New Applicatiop <br />4.2 New QuarryApplica[ion <br />4.4 Amendment Fee <br />4.5 Conversion to 112 operation (set by statute) <br />81.7 permitted acres <br />acre$ <br />81.7 acres <br />$2,344.00 application fee <br />$2,906.00 quarry application <br />$1,93$.00 amendment fee <br />~2~dd.01t^ conversion fee <br />5. Primary commoditie(s) to be mined Gravel Sand Dirt <br />5.1 Incidental commoditie(s) to be mined: 1. - Ibs/Tons/yr 2. / Ibs/Tons/yr <br />3. / Ibs/Tons/yr 4. / Ibs/Tons/yr $. / Ibs/Tons/yr <br />5.2 Anticipated end use ofprimary commoditie(s) to be mined: Road Construction, fill, concrete and asphalt hatching <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: <br />Hooker Construction LLP `~ <br />LLP <br /> <br />Hooker Gravel Pit <br />