PERMFILE55037

• Permit No: M2004036
• IBM Index Class Name: Permit File
• Doc Date: 5/5/2004
• Doc Name: 110c Appl
• From: Mason King
• To: DMG
• Media Type: D
• Archive: No

TATE OF,
DIVISION OF MINERALS AND GEOLOGY
Department of Natural Resources
1313 Sherman St., Room 215
Denver, Colorado 80203
Phone: [phone]
FAX: [phone]
CONSTRUCTION MATERIAIS
MAY 0 5 2004
Division sf Minerals and Geology
LIMITED IIHPACT (110) OPERATION /
RECLAMATION PERMIT APPLICATION FORM
~LORADO
V I a l O N O F
IN SRALS
EOLOGY
SAf ETT•SCrENCE
ein owen5
Governor
CHECK ONE: 17rere u a File Numb/e-r Already Assigned to this Operation
~Petmit # Zvi -.0~~- 0. i fG(rlease refereltce the Ste number cuaently assigned to this operaticm)
~_ New Application (Rule 1.4.5)
Conversion Application (Rule 1.11)
Amendment Application (Rule 1.10)
Pemrit # ~-_ ^ (provide for Amendments and Conveniona of existing permits)
Greg E. Walther
EzetNive Dinxmr
Ronald W. Caaany
Division Director
NaNaI Resource Trustee
The application foraConshTrctionMaterialsLimitedlmpact(110)OperationReclamationPermitcontainsthreelnajorparts: (1)theapplicatian
form; (2) Exhibits A-J, Exhibit L, Addendum 1, a~ sections of Exhibit 6.5 and Geotechnical Stability Exhibit, as required by the Ofl'ice, and
outlined in Rules 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) comolete signed and notarized IVORY ORIGINAL and one (1) copy oftbe completed I~ application form, two (2) copies of Exhibits
A-J, Exhibit L, Addendum 1, and appropriate sections of 6.5 (Geotechnical Stability Exhibit), as required, and a check for the application fee
described under (4) below. Exhibits should NOT be bound or in a 3-rmg bibeer; maps should be folded to 81/2" X 11" or 8 1 /2" X 14" size.
To expedite processing, please provide the int'otmation in the format and order described in this form.
GENERAL OPERATION INFORMATION
Type or prhlt clearly, in the apace provided, ALL information described behm/
1. AoplhcanUocerator or comoanv name (name to be used on Prrmit): Mason KinE /
1.1 Type of organization (corporation, partnership, etc.): Individual
1.2 1.2 I.RS. Tax ID No. or Social Security Number:
2. O_peratioo name (oit. mine or site Hamel: King Pit
3. Permitted acreaee (new or eaisNne site): 9. 9 permitted apes
3.1 Change in acreage (+) 0 acres
3.2 Total Acreage in Permit Area 9.9 acres
4. Fees:
4. ] New Application: 094.00 application fee
Amendment Fee(C.RS.34-32.5-125(11)): 719.00 application fee
4.2 Comersioa Fee (from 110d to 110 $875.00 camersion fee (Rule 1.11.2(2))
5. Pr®arvcommoditiefa)tO he mined: (:raval aan,t r•1 ay
5.1 Incidental commoditie(s) to be mined: 1. / lbs/fonslvr 2. / lbs/fons/vr 3. / ]bs/I'ons/vr
4. / Ibs/fons/vr 5. / Ibslfons/vr
5.2 Anticipated end use of primary commoditie(s)tobemined: i.andaraning- rnarlc fills
Anticipated end use of incidental commoditie(s) to be mined:
Office of Office of Colorado
Mined land Reclamation Active and InatYive Mines Geological Survey