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TATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />Depararlent of Natural Resourrxs <br />t 373 Sherman St, Room 215 _ C O L D RAD O <br />Denver, Colorado 80203 CONSTRUCTION MATERIAIS DIVISION O F <br />Phone: (303) 866-3567 MINERAL S <br />FAx: (303) 832-8706 REGULAR (112) OPERATION G E O L O G Y <br />RECLAMATION PERMIT APPLICATION FORM AECLAMATION•NINING <br />SAFETY•SCIENCE <br />Ba(l7WYlIS <br />CHECK ONE: There is a F•de Number Already Assigned to this Operation coYerlwr <br />Permit # ~vI -_ -_ (Please reference the file number c assi ed to this o ation Greg E. Walther <br />Utlr:Iltly gn ~ ) Executive Director <br />X NeEr Application (Rule 1.4.5) _ Amendment Application (Rule 1.10) Rauld w. Caaany <br />-' Divaion Din!trnr <br />_ Comenion Application (Rule 1.11) NaNai Resource Trustee <br />Permit # M -_ (provide for Amendmwta and Conversions of existing permits) <br />The application for a Conshuction Materials Regular 112 Operation Reclamation Permit contains three major parts: (1) the application form; <br />(2) Exhibits A-S, Addendum 1, any sections ofExhibit 6.5 (t3eotechnica] Stability Exhibit; and (3) the application fee. When you submityotn- <br />application, besure to include nine Q) complete sifined and notarized IVORY ORIGINAL and one (I) cePY ~'thetxsrfpleted I~ application <br />form, two (2) copies ofExhibits A-S, Addendum 1, applnpriate sections of 6.5 (Geotecbnical Stability Exlvbit, and a check for the application <br />fee tiescriimd tinder Sectiott (4) bllow. Exhibits should NO be bound or in a 3-tmg binder, maps should be folded to 81/2" X i l"or812" X <br />14° size. To expedite processing, please provide the iafortnation in the format and order described in this form. <br />GENERAL OPERATION INFORMATION <br />Type or prrmt clearly, in the space provided, ALL information requested below. <br />1. Aooficant/ooerafor or mmoanv name (name to be need on txemit): OTERO COUNTY <br />t.l Typeoforgauizatioa(corporation,pattnetship,etcJ: COUNTY GOVERNMENT <br />1.2 LRS. Tax I.D. No. W Social Sectnity Number: <br />2. Operation name (ok. mice or site name): OTERO COUNTY - MENDENHALL PIT <br />3. Permitted acteaee (new or a:fisting site): NEW SITE <br />3.1 Change in acreage (+) <br />3.2 Total acreage in Permit area <br />4. Fees: <br />4.1 New Application <br />4.2 New Quaily Application <br />4.4 Amendmart Fee <br />4.5 Conversion to 112 operation (set by statute) <br />~. Primary rnmmoditie(s) to be mined: SAND GRAVEL <br />5.1 Incidental commoditie(s) [o be mined: 1. NONE _ Ibslfons/vr <br />3. / Ibs/Tons/vr 4. / 16s/Tonsfc~r <br />724 permitted acres <br />acres <br />acres <br />$2 344.00 application fee <br />$2.906.00 quarry application <br />$1.938.00 amendment fee <br />$2.344.00 conversion fee <br />2. / lbs/fons/vr <br />5. / lbs/fons/vr <br />i2 Anticipated end use of pritttary commoditie(s) to be mined: ROAD MATERIAL <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: <br />Office of Office of Colorado <br />~~ •• ~.. ~___~__ Active and lnacfive Mina Geological Surve <br />