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IVISION OF MINERALS AND GEOLOi£NLL ~/U r T `~ <br />Department of Natural Resources r~,~ ^ A~~~~~~ MAR 012pp3 <br />1313 Sherman St., Room 215 il/ G D l V[ 5[ O N o f <br />Denver, Colorado 80203 Division •f Minerals and Geology MIN &RA L S <br />Phone: (303)666-3567 <br />FAX: (303)832-8106 <br />GEOLOGY <br />CONSTRUCTION MATERIAIS a E c t A M A n o N <br />MIN ING•SAFETY <br />REGULAR (112) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM eill Owens <br />Governor <br />Greg E. Walther <br />Executive Director <br />tECK ONE: X New Application (Rule 1.4.5) _ Amendment Application (Rule 1.1 ichael s. Long <br />~ivision Director <br />Conversion Application (Rule 1.11) <br />Permit # _~-,~~- ~~-~ -_ (provide for Amendments and Conversions of Busting permits) <br />e application for a Construction Materials Regular 112 Operafion Reclamation Permit contains three major parts: (1) the application farm; <br />~ Exhibits A-S, Addendum 1, any sections of Exhibit 6.5 (Geotechnical S tabilityF.xhibit and (3) the application fee. When yvu submit yrnu <br />plicaflon, be sure to include one (1) complete siened and notarized IVORY ORIGINAL and four (4) copies of the completed I~ <br />plicatlon form, five (5) copies of Exhibits A-S, Addendum 1, appropriate sections of 6.5 (Geotechnical Stability Exhibi4 and a check for the . <br />plication fee described under Section (4) below. Exhtbits should NOT be bound or in a 3-ring binder; maps should be folded to 8 1!2" X 11" <br />8 12" 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 requested below. <br />ADHlicant/ooerator or company name (name to be used on Hermit): Ran rh T an r3 T.T.(' <br />1.1 Type of organization (corporation, pazmership, etc.): T.T. f" <br />1.2 I.R.S. Tax I.D. No. or Social SectniryNumba: 84- ~ 5g56 1 1 <br />OHeration name (H it mine or site name): Ranch T and Rn r•k Pi t ~!? <br /> <br />Permitted acreage (new or eldstin¢ site): 240 permitted acres <br />3.1 Change in acreage (+) <br />3.2 Total acreage in Permit azea <br />Fees: <br />acres <br />240 acres <br />4.1 New Application $2344.00 application fee <br />4.2 New Quarry Application $2.906.00_ quarry application <br />4.4 AtnendmentPee $1.938.00 amendment fee <br />4.5 Conversion to 112 operation (set by statute) 52.344.00 conversion fee <br />Primary commoditte(s) to be mined: C>'ravel <br />5.1 Incidental commoditie(s) to be mined: 1. lbs/i'ons/yr <br />3. / lbs/Tons/vr 4. / lbs/Tons/vr <br />2. / lbs/fons/vr <br />5. / Ibs/Tons/vr <br />5.2 Anticipated end use of primazycommoditie(s)tobemined: construction material <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: <br />