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STATE OF COLORADO <br />~ DIVISION OF RECLAMATION, MINING AND SAFETY <br />'Department of Natural Resources <br />1313 Sherman St., Room 215 ~ <br />Colorado 80203 <br />Denver C O L O R A D O <br />, D I V I S I O N O F <br />Pltorm: (303) 86f>-3567 CONSTRUCTION MATERIALS RECLAMATION <br />Fix: (3D3i B32-Btob REGULAR (112) OPERATION M [ N [ NG <br /> - &- <br /> RECLAMATION PERMIT APPLICATION FORM SAFETY <br />Bill Owens <br />Governor <br />CHECK ONE: There is a File Number Already Assigned to this Operation arr,en ceage <br />Permit # M -_ ` _ (Please reference the file number currently assigned to this opera~FFf "'` D"`'`~Of <br />New A lication Rule 1.4.5 Amendtcent A licaion Rule 1.10 Ronald w. catbry <br />PP ( ) IrP ( ) Division Director <br />Conversion Application (Rule 1.11) Nmml Resourre Trustee <br />Permit # M -~ _ (provide for Amendments and Conversions of existing permits) <br />The application for a Construcion Materials Regular 112 Operation Reclamation Pemtit contains three major parts: (1) the application <br />form; (2) Ex)ibits A-S, Addendum 1, any sections of Exhibit 6.5 (Geoteclnical Stability Exhibit; and (3) the application fee. Wben you <br />submit your application, be sure to incltrde one (1) complete sired and notarized ORIGINAL sod one (1) copy of the completed <br />application form, two (2) copies of Exhibits A-S, Addendum 1, appropriate sections of 6.5 (Geotecltnical Stability Exhrbit, a~ a check for <br />the application fee descrtbed under Secion (4) below. Exhibits should NOT be boupd or m a 3-ring binder; maps should be folded to <br />8 1/2" X 11" or 8 1/2" X 14" size. To expedite processing, please provide the information in the foment and order descnbed in this form <br /> GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space prrov(ded, AI.L information requested below. <br />1. Ap plicanUocerator or rnmnanv name (game to be used on cerr~tl: <br /> 1.1 Type of organization (corporation, partnership, etc.): <br />2. Oce ration name (nit. mine or site camel: <br />3. Permitted acrea¢e (new or ezistine aitel: pemitted acres <br /> 3.1 Cltangein acreage(+) acres <br /> 3.2 Total acreage in Permit area acres <br />4. ems: <br /> 4.1 New Application $2.344.00 application fee <br /> 4.2 New Quarry Application $2.906.00 quarry application <br /> 4.4 Arnendntent Fee $1,938.00 amendment fee <br /> 4.5 Conversion to 112 operation (set by statute) $2.344.00 conversion fee <br />5. Primarv commoditie(sl to be mined: <br />5.1 Incidental comtmdite(s) to be mined: 1. Ibs/Tons/yr <br />3. / lbs/fons/vr 4. / lbs/i'onslvr <br />5.2 Anticipated end use of pruttary cormmodiie(s) to be mined: . <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: <br />Office of <br />Mi„a,1 1 and Rerlarrurinn <br />2. / Ibs/1'onslvr <br />5. / lbsrfpns/yr <br />Office of <br />/uxive and Inactive Mina <br />