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<br />~' .. • <br />FiECEI ~~ f9sa~ a/,o9~-= <br />ATE OF COL~IZADO <br />' DIVISION OF MINERALS AND GEOLOGY MAR Z 4 ZOOS <br />Deparcment of Natural Resources <br />t3r3 Sherman Sc, Room 2ts Division of Minerals and Geology ~ t v ~ s r o N o f <br />Denver, Colorado 80203 <br />Phone: (303) 566-3567 ~ ~ ~ ~ 1. 1'J E R-4 L $ <br />FAX: (303) 832-8706 CONSTRUCTION 11'LhTEI<.IA.I,S ~ <br />~~~ ~~~~ G E O L O G Y <br />LIMITED LlIPACT (110) OPERATION `/ R E C L A M AT I O N <br />~+ //~~Ap~~J/~~~~ MINING•SAEETY <br />®~ a~ ~/~A/N/NI LAMATTON PEI2AIIT APPLICATION FORM <br />BiII Owens <br />Gnvemor <br />' Greg E. \Malcher <br />CHECK ONE: There is a File Nnmper Already Assigned to this Operation E,ec~ci~e Director <br />r/ Ronald W. Cattany <br />Permit # M ~~ D~ -_ (Please reference the file nt>$ber cturently assigned to this operation) Acting Division Director <br />% New Application (Rule 1.4.5) Amendment Application (Rule 1.10) <br />Conversion Application (Rule 1.11) <br />Pemrit # 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 i, any sections of Exhibit 6.5 and Geoteclmical Stability Exhrbifi, as required by the <br />Office, and outlined in Rules 6.1, 6.2, 6.3, 6.5, and 1.62(1)(b); and (3) the application fee. When you submit your application, be sure to <br />include one (1) comolete signed and notarized IVORY ORIGINAL and one (1) copy of the completed No application form, two (2) copies <br />of Exhibits A-J, Exhibit L, Addendum 1, and appropriate sections of 6.5 (Geoteclwical Stability Exhibit), as required, and'a check for the <br />and lirafinn fea.desnnbed under j4}beloa~- Fxh;h;:~ ~t~a:,t,t'~TO'F be bounder sa-a 3-ang Binder, maps slioild be #'olded to 8 l-/2" X 1 l " or <br />8 1/2" X 14" size. To expedite processing, please provide the information in the format and order described in this form. <br />GENE1tAL OPERATION INFO]tMATION <br />Type or print cleazly, in the space provided, ALL information described below: <br />Aonlicantlonerator or comnanv name (name to be used on oermkl: Phillius County <br />I.1 Type of organization (corporation, partnership, etc.): Government <br />1.2 I.RS. Tax ID No. or Social Security Number. 2.: <br />2. Operation name (nit. mine or site name): <br />3. Permitted acreage (new or existin¢ site): <br />3.1 Change in acreage (+) <br />3.2 Total Acreage in Permit Area <br />4. Fees: <br />4.1 New Application: <br />Amendment Fee (C.RS. 34-32.5-125(II)): <br />4.2 Conversion Fee (from 110d to 1I0 $875.00 conversion fee (Rule 1.11.2(2)) <br />9. 9 permitted acres <br />0 acres <br />9:9 acres <br />$1.094.00 application fee <br />$719.00 application fee <br />5. Prhnarvcommoditie(s)tobemined: Gravel Sand . <br />5.1 Incidental commoditie(s) to be mined: 1. 1 lbs/Tons/vr 2. / 1bs/Tons/vr 3. / lbs/Tons/vr <br />4. / Ibs/Tons/vr 5. / ]bs/T'ons/vr <br />5.2 Anticipated endnseofprimarycommoditie(s)tobemined: Road eravel sand base material <br />Anticipated end use of incidental commoditie(s) to be mined: <br />