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TATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY RE~ElVED <br />Department of Natural Resources <br />1313 Sherman St., Room 215 MAR 16 2004 / C O L O RA D O <br />Denver, Colorado 80203 CONSTRUCTION MATERIALS DIVISION o E <br />M[ N E RA L S <br />Phone: (303)866-3567 <br />EAx: (303) a32-Bt06 REGULAR Q 12) OPERATTON OivisiGr. of l ........_ . &eology G E O L O G Y <br /> RECLAMATION PERMIT APPLICATION FORM RECLAMATION • N I N I N G <br /> SAFETT•SCIENCE <br />CI-IE.CK ONE: ~ There is a Fik Number Already Assigned to this Operation <br />/ Permit # M -Z o t7V -~ C~Please reference the file number currently assigned [o this operation) <br />New Application (Rule 1.4.5) _ Amendment Application (Rule 1.10) <br />Conversion Application (Rule L [ I ) <br />Permit # M -_ _ (provide for Amendments and Conversions of existing permits) <br />Z~oO. Z permitted acres <br />The application for a Construction Materials Regulaz 112 Operation Reclamation Permit contains three major parts: (1) the application form; <br />(2) Exhibits A-S, Addendum l ,any sections of Exhibit 6.5 (Geotechnical Stability Exhibit; and (3) the application fee. When you submit yow <br />application, be sure to include one (]) complete signed and notarized IV ORY ORIGINAL and one (1) copy of the complettxl Ivory application <br />form, hvo (2) copies of Exhibits A-S, Addendum 1, appropriate sections of 6.5 (Geotechnical Stability Exhibit, and a check for the application <br />fee described [order Section (4) below. Exhibits should NOT be bound or in a 3-ring binder; maps should be folded to 8 12" X 11"or 812" X <br />14" size. 1'o expedite processing, please provide the information m the format and order described in this form. <br />GENERAL OPERATION INFORMATION <br />or print ckerly, in the space provided, ALL information requested bebw. <br />1. Apolicant/onerator or tnmaanvname (name to be used on Dermit): A/J.A. ~oncrC{~ ~on sfiucfi'0 n <br />1.1 Type of organization (corporation, partnership, etc.): Go /o ra c% /o r~ o/a-,Li or! <br />1.2 LR.S. Tax LD. No. or Social Security Number: <br />2. Operation name (oit" mice or ake name): ~OLE I.YAVEL ~ T / <br />3. Permitted acease (new or eaistina akel: <br />3.1 Change in acreage (+) <br />3.2 Total acreage in Permit azea <br />4. Fees: <br />4.1 New Application <br />4.2 New Quarry Application <br />4.4 Amendment Fee <br />4.5 Conversion to ] 12 operation (set by statute) <br />~. Priman• commoditie(s) to be mined: ~ZlGr1~ a t_° <br />5. ] Incidental commoditie(s) to be mined:~t/fa. - Ibs/fonshT <br />3. / Ibs/Tons/vr 4. / ]bs/TottshT <br />Bill Owens <br />Governor <br />Greg E. Walther <br />Executive Director <br />Ronald W. CatUny <br />Division DIfCLTOr <br />Natural Resource Trustee <br />acres <br />acres <br />$2344.00 application fee <br />$2,906.00 quam' application <br />$1.938.00 amendment fee <br />$2344.00 conversion fee <br />2. / Ibs/TonshT <br />~. / lbs/Tonsh~r <br />5.2 Anticipated end use of primary commoditie(s) [o be mined: Co nS7/rl CTio n ma7Cria <br />5.3 Anticipated end use o1'inciden[al commoditie(s) to be ruined: <br />Office of Office of Colorado <br />Mined Land Reclamation Active and Inactive Mines Geological Survey <br />