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IVISION OF MINERALS AND GEOLOGY <br />Department of Natural Resources <br />1313 Sherman SL, Room 215 <br />Denveq Colorado 80203 <br />Phone: (303) 866-3567 <br />FAX: (303) 832-8106 <br />DIVISION O F <br />OCT ' ~ ~ MIN&RALS <br />GEOLOGY <br />,pQ{~ RECLAMATION <br />CONSTRUCTION MATEBIALS DlMieiOn d~ Qti0I0pI MINING • 5 A F E 7 Y <br />REGULAR (112) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />CHECK ONE: ~_ There b a Fr7e Number Already Assigned to this Operation <br />Permit # M 2002_ 111 __ (please reference the fde number currently assigned to this operation) <br />New Application (Rule 1.4.5) _ Amendment Application (Rule 1.10) <br />Conversion Application (Rule 1.11) <br />Permit # M - -_ (provide for Amendments and Conversions of existing pemtits) <br />Bill Owens <br />Governor <br />Greg E. Walther <br />Executive Director <br />Ronald W. Cottony <br />Acting Division Director <br />The application for a Construction Materials Regular 112 Opemtion Reclamation Pert contains three major parts: (1) the application form; <br />(2) Exhibits A-S, Addendum 1, a~ sectiops of Exhibit 6.5 (Geotwhuical Stability Exhibit and (3) the apglication fee. When you submit your <br />application, be sm+e to include one (1) complete siffied mmd notarized IVORY ORIGINAL mmd one (1) copy of the completed Iii application <br />form, two (2) copies of Exhibits A-S, Addendum 1, appropriate swoons of 6.5 (Gwtwhaical Stability Exhibit, and a check far the application <br />fce descnbed under Swtion (4) below. Exhibits shwld NOT be bound or in a 3-ring binder; maps should be folded to S 1/2" X 17" or 8 I/2" <br />X 14" size. To expedite processing, please provide the information in the format and order descnbed in this form. <br />GENETtAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, ALL information requested below. <br />1. Aonlicant/ocerator or comoanv name (name to be used on permit): E 1 am Construction , Inc . <br />1.1 Type ofor~ani~arinn(corporalion,par[neiship,ete.): Colorado Corporation <br />1.2 I.RS. Talc I.D. No. or Social Swutity Number: <br />STATE OF COLORADO <br />,, .. <br />84-0484380 <br />2. Operation name (ok, mine or site Hamel: G 11 Soul to Gravel P i t <br />3. Permitted acreage (new or eXistino site): 69.27 permitted a::res <br />3.: Change in acreage (=) <br />3.2 Tots'. acreaee i-t Per, rt uea <br />4. Fees: <br />4.1 New Application <br />4.2 New Quarry Application <br />4.4 Amendment Fee <br />4.i Conversion to 112 operation (set by statute} <br />~. Primary commoditie(s) to be miced: Sdnd Gravel <br />5.1 Incidental commoditie(s) to be mined: 1. Ibs/Tons/vr <br />3. / lbs/Tonslvr 4. / lbs/1'ons/v. <br />acre, <br />aczcs <br />$2,344A0 application fee <br />52,906.00 quarry application <br />SL938.00 amendmeWtfee <br />$2.344.00 conversion fee <br />2. / Ibs(Cons/vr <br />5. ! 1bsrTonshr. <br />5.2 Anticipated end use of primary commoditie(s)tobemined: Construction Materials <br />5.3 Anticipated end use of incidental commodite(s) to be mined: Non e <br />