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<br /> <br />999 <br />~ I g~S v d <br />• <br />STATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />Depanmem of Natural Resources <br />1}17 Sherman Sr.. Room '15 <br />Denver, Color. du 80203 <br />Phnnc: (}U 31 SG6-3567 <br />)~mcuraT.g <br />REGOLAR (112) OPERATION <br />@iTION PERMIT APPLICATION FORM <br />~~~ <br />DEPART.MEIVI' OF <br />~ECE(VEDRESOLUTR~ CES <br />JUL ~ 2 1999 kav Romer <br />Governor <br />4 lame>5 Lochhead <br />li7~n,,~Ul l Vi fd~n8ra(~ & Geol~v11•e p.reco~ <br />, nrirhael B Long <br />Division Director <br />CHECK ONE: ** New Application (Rule 1.4.5) Amendment Application (Rule 1.10) <br />Conversion Application (Rule 1.11) <br />Permit #~-~-~~ -_ (provide for Amendments and Conversions of existing <br />permits) <br />The application for a Construction Materials Regular 112 Operation Reclamation Permit contains <br />three major parts: (1) the application form; (2) Exhibits A-S, Addendum 1, any sections of <br />Exhibit 6.5 (Geotechnical Stability Exhibit; and (3) the application fee. When you submit your <br />application, be sure to include one (1) complete sinned and notarized IVORY ORIGINA7, and four (4) <br />copies of the completed Ivory application form, five (5) copies of Exhibits A-S, Addendum 1, <br />appropriate sections of 6.5 (Geotechnical Stability Exhibit, and a check for the application fee <br />described under Section (4) below. Exhibits should NOT be bound or in a 3-ring binder; maps <br />should be folded to 6 1/2" X 11" or 8 1/2" X 19" size. To expedite processing, please provide <br />the information in the format and order described in this form. <br />------------------------------------------------------------------------------------------ <br />--------------------------------------------------------------------------------------------- <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, ALL information requested below. <br />------------------------------------------------------------------------------------------- <br />-------------------------------------------------------------------------------------------- <br />1 <br />2 <br />3 <br />4 <br />5 <br />AHOlicant/oHerator or company name (name to be used on Hermit): <br />1.1 Type of organization (corporation, partnership, etc.): County government <br />1.2 I.R.S. Tax I.D. No. or Social Security Number: 84-6000786 <br />Operation name (Hit, mine or site name): Ormiston Gravel Pit <br />Permitted acreage (new or existinc site): ±28 permitted acres <br />3.1 Change in acreage (+) acres <br />3.2 Total acreage in Permit area ±28 acres <br />Fees: <br />5.2 Anticipated end use of primary commoditie(s) to be mined: road construCtiOn <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: <br />9.1 New Application S1,875.00 application fee <br />9.2 New Quarry Application 52,325.00 quarry application <br />4.3 Milling Application (Non-DMO) 53,100.00 milling application <br />9.9 Amendment Fee __ $1,550.00 amendment fee <br />4.5 Conversion to 112 operation (set by statute) 51,875.00 conversion fee <br />Pr+T=*+• commoditie(s) to be mined: gravel aggregates <br />5.1 Incidental commoditie(s) to be mined: 1. lbs/Tons/vr <br />2. / lbs/Tons/vr 3. / lbs/Tons/vr <br />9. / lbs/Tons/vr 5. / lbs/Tons/vr <br />