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~~ ~ III IIIIIIIIIIIIIIII ,~ti ~~7 <br />~~ATE OF COLCUi~00 <br />DI\'1510N QF ,vtINERALS AND GEOLOGN <br />Drpanmrnl ul Ncwral Be,nurces <br />I} U Shuman SL. Faom J l i <br />Dr•ner. Culorado 8U_U3 <br />Phune' (3031 866 }jb7 <br />F.~x I3n3~ e}~ slob <br />CONSTRUCTION MATERIALS <br />LIM1IITED IMPACT (110) OPERATION <br />~~~IGi~' =tW <br />~qAY ~ 5 2G0~ <br />~,~gpn cf f~inelals 3 GeciogY <br />DIVISION OF <br />MINERALS <br />GEOLOGY <br />REC LA r-IATION <br />Hf NING•SAFETY <br />Bill over„ <br />Governor <br />Greg E. Walther <br />RECLAMATION PERMIT APPLICATION FORM Execmive Dueaur <br />Michael B. Lang <br />Division Director <br />CHECK ONE: XXX New Applicarion (Rule 1.4) Conversion Application (Rule t.] 1) <br />Amendment Application (C.R.S.34-32.5-1 IO) <br />Permit # 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 paRS: (1) the application form: <br />(2) Exhibits A-1, Exhibit L, Addendum 1, any secdons of Exhibit 6.5 and Geotechnical Stability Exhibit, as required by the Office, and outlined ti Rules <br />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 sure to include one (1) compete signed and <br />notarized IVORY ORIGINAL and one (I) copy ofthe completed Ivory application form, two (2) copies of Exhibits A-], Exhibit L, Addendum 1, and <br />appropriate sections of 6.5 (Geotechnical Stability Exhibit), as required, and a check for the application fee described under (4) below. Exhibits should <br />NOT be bound or in a 3-ring binder, maps should be folded to 8 1R" X 1 I" or 8 1R" X 14" size. To expedite processing, please provide the information <br />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 />B & D Trucking <br />1. Apolicant/ooeratar or comoanvname (name to be used o0 oermitl: Robert & Dorothy Goode <br />I.1 Type of organization (corporation,parmership,etc.): sole ownership <br />1.2 I.R.S. Tax ID N o. or Social Security N umber: <br />2. Operation name (oil, mine or site name): B & D T <br />3. Permitted acrea¢e (new or ezistine site): <br />3.1 Change in acreage (+) <br />Total Acreage in Permit Area <br />4. Fees <br />less than 10 perminedacres <br />0 acres <br />less than 10 acres <br />4.1 New Application: $875.00 application fee <br />Amendment Fee (C. R.S. 34-32.5-125(11)): 575.00 application fee <br />4.2 Conversion Fee (from I IOd to 110 875.00 conversion fee (Rule 1.111(2)) <br />5. Primary commoditie(slto be mined: toa soil <br />5.1 Incidental commoditie(s) to be mined: I. / Ibs~fons/yr 2. / lbslions/vr 3. / Ibslfonslvr <br />4. / Ibslfons/vr 5. / Ibs/fons/yr <br />5.2 Anticipated end useotprimarycommoditie(s)tobemined: top soil to be used for lawn & gardens <br />..3 Anticipated end use of incidental commoditie(s) co be mined: <br />