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9osa ~a, 3~f~l,uo <br />STATE OF <br />DIVISION OF MINERALS AND GEOLO <br /> <br />Department of Natural Resources ~'~ <br />E C O P Y <br />1373 Sherman St., Room 275 <br />Denver, Colorado 80203 ~®~ <br />~~ <br /> <br />Phone: (303) 866-3567 s <br />I"9/r/I,~~ <br />FAX: (303)832-8106 <br />CONSTRUCTION MATEBIALS <br />REGULAR (112) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />~ECEi QED <br />/MAY 1.4 X113 <br />Division ~/Minerals alnd c"".. <br /> <br />CHECK ONE: There m a Ft7e Number Already Assigned to this Operation <br />Permit # M -_ _ _ (Please reference the file nmmber currently assigned to this operation) <br />New Application (Rule 1.4.5) _ Amendment Application (Rule 1.10) <br />Conversion Application (Rtile 1.] 1) <br />Permit # M -- -_ (provide for Amendments and Conversions of existing permits) <br />DIVISION O F <br />MINERALS <br />GEOLOGY <br />RECLAMATION <br />MINING~SAFETY <br />Bill Owens <br />Governor <br />Greg E. Wakher <br />Executive Director <br />Ronald W. Cottony <br />Acting Division Director <br />The application for a Construction Materials Regular 112 Operation Reclamation Petmit contains three major pans; (1) the application form; <br />(2) Exhibits A-S, Addendnm 1, a~ sections of Exlibil6.5 (Geoteclmical Stability Exlubi[; and (3) the application fee. When you submit your <br />application, be sore to incltaie one (1) complete siffied and notarized IVORY ORIGINAL and one (I) copy of the cgmpleted Ivot application <br />form, two (2) copies of Exhibits A-S, Addendum I, appropriate sections of 6.5 (Geoteclmical Stability Exhibit, and a check for the application <br />fee described nnder Section (4) below. Exltibits should NOT be Iwund or in a 3-ring binder; maps should be folded to 8 1!2" X 11" or 8 1/2" <br />X 14" size. To expedite processing, please provide the information in the format and order described in this form, <br />GENERAL OPI~tATION INFORMATION /~ / <br />Type or print clearly, in the space provided, AI,L information requested below. ~ ~W3~~/ <br />ADDIiCant/ODerator OT COmDanV nHme (name t0 be Uaed On Dermltl: }~ 7 1 - T s" .ri n rn r nn v~~ ~ i n n ~ <br />1.1 Type of organization (corporation, partnership, etc.): CO rp0 ra t i o n <br />1.2 I.RS. Tax I.D. No. ar Social Security Number: <br />2. Operation name (pit, mine or site Hamel: N1552t1 Farm R2$DUrCe <br />3. Permitted acreage (new or esistinQ sitel: <br />3. h Change in acreage (+) <br />3.2 Toia'. acreage i,-tPer~~t uea <br />4. Fees: <br />4.1 New Application <br />4.2 New Quarry Application <br />4.4 Amendment Fee <br />4.5 Conversion to 112 operation (set by statute) <br />5. Primary commodiie(s] to be mined: Sand Gravel <br />5.1 Incidental commoditie(s) [o be mined: 1. ~n h d - .ri Ibs/'lZdttli(vr <br />134 - 21 + permitted a,:res <br />acres <br />acre, <br />$2.344.00 application fee <br />$2.906.00 quarry application <br />$1.938.0 ameudmeut fee <br />$2.344.00 conversion fee <br />2. / ~ Ibs/Coris/vT <br />3. / Ibs/fonslvr 4. / Ibs/Tons/vr 5. / Ibs/Tonshr. <br />5.2 Anticipatedendtueofprimarycommoditie(s)tobemined: Construction Materials <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: <br />