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II IIIIIIIIIIIIIIII <br />STATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY RECEIVED <br />Depanmeni ni N,i¢iral Resources <br />I S I S ~hemran Sr . Room ' 15 <br />Denver, Culorar~o anwa MAY t k 2001 D I V ~ S ~ O N O F <br />Phone: itnai set,-}Sh; MINERALS <br />rnx iso3intz.atob & ~ <br />Oiyisian of Minerals and Geology GEOLOGY I <br />0.EC LA MA710NI <br />CONSTRUCTION MATERIALS MINING • S A F E T Y <br />REGULAR (112) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM BillOwens <br />Governor <br />G~eti E. Watcher <br />E.ecuuve Director <br />CHECK ONE: New A lication Rule 1.4.5 Amendment A lication (Rule 1.10`" `hde~ a. Loos <br />~- PP ( ) PP Dimsion Dnector <br />Conversion Application (Rule 1.1 l ) <br />Permit # M -o~~~-_ (provide for Amendments and Conversions of existing permits) <br />The application for a Cotrswction Mazerials Regular 112 Operation Reclamation Permit contains three major parts: (I) the application form; <br />(2) Exhibits A-S, Addendum 1, arty sections of Exhibit 6.5 (Geotechnical Stability Exhibit; and (3) the application fee. When you submit your <br />application, be sure to include one (I) comolete signed and notarized IVORY ORIGINAL and four (4) copies of the completed Iv_o~r <br />application form, five (5) copies of Exhibits A-S, Addendum 1, appropriate sections of 6.5 (Geotechniral Stability Exhibit, and a check for <br />the application fee described under SeMion (4) below. Exhibits should NOT be bound or in a 3-ring binder; maps should be folded to <br />8 I f2" X l 1" or 8 I/2" X 14" size. To expedite processing, please provide the informarion in the format and order described in this form. <br />GENERAL OPERATION INFORMATION ,P~cpfS(39 QI,~IS,d <br />Type or print clearly, io the space provided, ALL ioformatioo requested below. ~6/~ ~ y~9•o0 <br />I. AoolicanVooeratororcomoaovoamefnametobeusedoooermitl: wAG+arn_Mnhi1F? Northern. Ine, <br />I.l Type oforganization (corporation,parmership,etc.): Corporation <br />l.2 I.R.S. Tax I.D. No. or Social Security Number: <br /> <br />2. Otreratioonamefoit.mineorsitenamel: North Taft Hill <br />3. Permitted acreage (oew or esisting site): <br />3.1 Change in acreage (+) <br />3.2 Total acreage in Permit area <br />4. Fees: <br />4.1 New Application <br />4.2 New Quarry Application <br />4.3 Milling Application (Nort-DMO) <br />4.4 Amendment Fee <br />4.5 Conversion to 112 operation (set by statute) <br />Site <br />permitted acres <br />acres <br />5 1 . 1 8 acres <br />51.875.00 application fee <br />52.325.00 quarry application <br />53.100.00 milling application <br />SI.550.00 amendment fee <br />SI.875.00 conversion fee <br />5. Primary commoditie(s) to be mined: Sand Gravel <br />5.1 Incidental commoditie(s) to be mined: 1. N / A - Ibs/I'ons/vr <br />3. / Ibslfons/vr 4. / Ibs/Ions/vr <br />2. / Ibs/fons/vr <br />S. ! Ibs/fonslvr <br />5~ Anticipated end use of primary commoditie(s)tobemined: Construction Materials <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: N / A <br />