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Ff <br />CONSTRUCTION MATERIALS <br />REGULAR (1 ]2) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />CHECK ONE: There is a F91e Number Already Assigned to this Operation <br />Tely o0 <br />s <br />Permit # M -_ ^ _ (Please reference the file number currently assigned to this operation) <br />X New Application (Rule 1.4.5} Amendment Application (Bute I.10) <br />Conversion APPlication (Rule 1.11} <br />Permit # M - - - (provide for Amendments an¢ Conversimts of existing permit <br />The application for a Construdias Materials Regular 112 Operatics Reclamation Permmjtcontaittsthrce gTjor parts: (1) the app(i cation <br />form; (2} Exhibits A-5, Addendum I, any sections of E~dtibjt 6.5 (Geotechsical Stability Exhibit; and (3}the application foe W}ten you <br />submit your applicati~, be sure to inr~l pde pne ,()) cpq~plete signed and notarized ORIGINA(. and one (1) copy of the com pleted <br />application form, two (2) copies of Exhibits A-S, Ad en , appropnate sections o eotec ical Stabilit~l¢t~it, apd a check for <br />the application fee described under $edion (4) below. Exhibits should NO')' be bound or in a 3-ring birtda; m aps should 6e folded tp <br />8 1/2 X 11" or 8 1/2" X 14" size. To expedite processing; please provide the information in the format and order described in this form <br />Type or ptipt clearly, in tltespppc prpyi¢ed, A(.~, information requested below. <br />] . ApplicanUoperator or company name (name to be used on permit) <br />1.1 Type of organization (corporation, pa>:mersbig, etc.): <br />1.2 I.RS. Tax I.D. No. or Social Security Number: <br />2. Operation nazne (pit, mine or site named <br />3. Permitted acreage {new or existing site) <br />3.1 Change in acreage (+) <br />3.z ')'ptal acreage in Permit area` ' <br />~:. <br />4 Fees: <br />4T New Applicatiop <br />4.2 Nets Quarry Applicatiop <br />4.4 Amendtpegt Fee <br />4.5 Conversion to 1 ]2 operation (set by statute) <br />81.7 permitted acres <br /> ~eS <br />81.7 saes <br /> <br />$2,44.00 application fed <br />$2,9A6.D0 4uarryaPPliwtiaq <br />$1,Qj$.OQ amendment feG <br />-5~;34~6i~ conversion fe4 <br />5. Primary commoditie(s) to be mined Gravel Sand Dirt <br />5.1 lncidenta! comtoditie(s} to be miped: ). ' tbslTotts/y~ 2. / i~slTons/yj <br />3. / 1bstTons/yr 4. / IjsrJ'onstyr ~. / ]bs~Tons/y1 <br />5.2 Anticipated end use ofprimary commoditie(s) is be miped: Road Cosstrnctisn, lily coscrcte and asphalt botching <br />5.3 Anticipated end use ofincidental commoditie(s) to be milted: <br />Hooker Construction LLP <br />LLP <br /> <br />Hooker Gravel Pit <br />~~~~'63° <br />