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l - ~-v-o ~-oro ~ <br />r%0/'Pf~t--r~zs <br />STATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY ~~~,~ Cpprl~' RECEIVED ~~~ <br />Department of Natural Resources ^_d /~1 <br />1313 Sherman St, Roam 215 ~~~ M VJ'~NN®~(~, y pp q <br />Denver, Colorado 80203 AI 2 8 2U~L - D 7 v I S 1 0 N O <br />Phone: (303) 866-3567 <br />FAx: (303)832-8106 <br />R ~ ~.,' E ~A,~ E D Division of Minerals and Geology <br />CONSTRUCTION MATERIALS <br />JUN ~ $ 20OY REGULAR (112) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM '~ <br />Division of Minerals and Gealogy <br />MINERAL <br />GEOLOGI <br />0. EClA MATION <br />MIN ING•SAFETY <br />Bill Owens <br />Governor <br />Greg E. Walther <br />Ezeculive Director <br />CHECK ONE: There is a File Number Already Assigned to this Operation Michael B. Long <br />Division Uireclor <br />Permit # M -~a-~-_ (Please rference the file number curenily assigned [o this operation) <br />R New Application (Rule 1.4.5) _ Amendment Application (Rule 1.10) <br />Conversion Application (Rule 1.11) <br />Permit # M -_ -! (provide for Amendments and Conversions of existing permits) <br />The application for a Consuuction Materials Regulaz 112 Operation Reclamation Permit contains three major parts: (1) the application <br />form; (2) Exhibits A-S, Addendum 1, any sections of Exhibit 6.5 (Geotechnical Stability Exhibit and (3) the application fee. When you <br />submit your application, be sure [o include one (1) complete sinned and notarized IVORX ORIGINAL and four (4) copies of the <br />completed Ivory application form, five (5) copies of Exhibits A-S, Addendum 1, appropriate sections of 6.5 (Geotechnical Stability Exhibit, <br />and a check for [he application fee described under Section (4) below. Exhibits should NOT be bound or in a 3-ring binder; maps should <br />be folded to 8 1/2" X 11" or 8 1/2" X 14" size. To expedite processing, please provide the information in the forma[ and order described <br />in this form. <br /> GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, all information described below. <br />I. Au Plicantlooerator or comnanv name (name to be used on permit): Prowers County ~ <br /> 1.1 Type of organization (corporation, partnership, etc-): COUNTY GOVERNMENT <br /> 1.2 I.R.S. Tax I.D. No. or Socia] Security Number: <br />2. Op eration name (pit, mine or site name): DAMS PIT / <br />3. Permitted acreaee (new or existine site): 105.35 permitted acres <br /> 3.1 Change in acreage (+) acres <br /> 3.2 Total acreage in Permit area 105.35 acres <br />4. Fees: <br /> 4.1 New Application $2.344.00 application fee <br /> 4.2 New Quarry Application $2,906.00 quarry application <br /> 4.4 Amendment Fee X1,938.00 amendment fee <br /> 4.5 Conversion [o t ] 2 operation (set by statute) ~ $2,344.00 conversion fee <br />5. Primary commoditie(s) to be mined: SAND GRAVEL ROAD MATERIALS <br /> 5.1 Incidental commoditie(s) to be mined: 1- / Ibs/Cons/yr 2. / Ibs/Tons/vr 3. / Ibs/fons/vr <br /> 4. / Ibs/Tons/vr 5. / Ibs/I'ons/vr <br /> 5.2 Anticipated end use of primary commoditie(s) to be mined: ROAD MA TERIAL <br /> 5.3 Anticipated end use of incidental commoditie(s) to be mined: <br />