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i/~-~a'd /-0~7 <br />CONSTRUCTION MATERIALS <br />REGULAR (112) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />CHECK ONE There is a File Number Already Assigned [o this Operation <br />REC~~° ;=~~' <br />,/ OCT 2 C 2004 <br />Division of Miuat_ <br />Perms # ~-_ ~ _ (Please reference the file number currently assrgned to this operation) <br />_~ New Apphra[ton (Rule ] 4 5) _ Amendment Application (Rule 1.10) <br />Conversion Application (Rule i l l) <br />Permit # M -_ _ _ (provtde for Amendments and Conversions of existing permits) <br />The apphcanon for a Construction Materials Regular 112 Opemtion Reclamation Permit contains three maior parts (1) the application <br />form, (2) Exhtbrts A-$ Addendum I, any sections of Exhtbu 6.5 (Geotechntcal Stability Exhibit, and (3) the apphcanon fee. When you <br />submit your application, be sure to include one (1) complete sieved and no rued ORIGINAL and one p) copy of the completed <br />apphcanon form, mo (2) copses of Exhtbns A-S, Addendum I, appropriate sections of 6.5 (Geotechnical Stability Exhibit, and a check for <br />[he application fee described under Sec[ton (4) below Exhtbns should gLoT be bound or in a 3-ring border, maps should be folded to <br />8 lt2" X l l" or 8 l2" X l4" sze. To expedite processing, please provtde the tnformatron m the format and order described m this form <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, ~L_L information requested below. <br />I ApolicanUotierator or comoanv name !name to be used on permltl: Clear Creek District Water PfoVlders. LLC <br />I I Type of organization (corporation, partnership, etc.): Limited Liability Corporation _ <br />12 I R.S Tax I D No or Soctal Security Number 70-1 dgg4gQ / <br />2. Ooeration nameloit. mine or site name): MMRR QUarry / <br />3 Permitted acreaee (new or existine site) 526.70 permitted saes <br />3 I Change in acreage (+) acres <br />3 2 Total acreage m Permit azea 526.70 acres <br />4 Fetes <br />4 I New Application 52.344 00 application fee <br />~2 New Quarry Application 52.906.00 quarry apphcanon <br />4 4 Amendment Fee 51.938.00 amendment fee <br />4 5 Conversion to 112 opemtion (set by statute) 52.344 00 conversion fee <br />5 Prim ary commoditiefsl to be mined: SpeCItlCatlOn Cpn$tructi4n AQgregateS <br />5 1 Incidental commoditie(s) to be mined: 1 N/A - IbslTons/vr 2 / Ibs?ons/vr <br /> 3 / Ibs/fons/vr 4 / Ibs/Tons/yr 5. / Ibs~l'ons/vr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: COr1StfUCtlOn AggreqateS (all tVOBS) <br />5 3 Annapated end use of mctdental commoditie(s) to be mined. N/A <br />