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<br /> STATE OF COLORADO <br />DIVISION Of MINERALS AND GEOLOGY RECEIVED <br />Department of Natural Resources ~ <br />p/b <br />1313 Sherman St., Room 215 <br />Denver, Colorado 80203 ~®R sC~• N~' / <br />~/ <br />e1/('l, <br />AY 2 8 2002 - ° ' "' S ' ° " ° <br />Phone: (303) 866-3567 - (v1 I iV E R A L <br />FAX:(303)832-8106 ~ &- <br />~1fviSion of Minerals and Geology G E O L O G <br /> CONSTRUCTION MATERIALS <br /> REC LA MATIO <br /> REGULAR (112) OPERATION MINING • S A F E T <br />RECLAMATION PERMIT APPLICATION FORM <br />Bill Owens <br />Governor <br />Greg E. Walther <br />Executive Director <br />CHECK ONE: There is a File Number Already Assigned to this Operation Michael 8. long <br />Division Uirectar <br />Permit # M -~ja-~-_ (Please reference the file number currently assigned [o this operation) <br />% New Application (Rule ].4.5) _ Amendment Application (Rule 1.10) <br />Conversion Application (Rule 1.11) <br />Permit # M -V -_ (provide for Amendments and Conversions of existing permits) <br />The application for a Construction Materials Regular 112 Operation Reclamation Petmit contains three major parts; (I) the application <br />form; (2) Exhibits A-S, Addendum 1, any sections of Exhibit 6.5 (Geotechnical Stability Exhibit; and (3) the application fee. When you <br />submit your application, be sure to include one (1) complete sinned and notarized IVORY ORIGINAL and four (4) copies of Che <br />completed Ivorv application form, five (5) copies of Exhibits A-S, Addendum 1, appropriate sections of 6.5 (Geotechnical Stability Exhibit, <br />and a check for the application fee described under Section (4) below. Exhibits should NOT be bound or in a 3-ring binder; maps should <br />be folded to 8 1/2" X I 1 " or 8 I/2" X 14" size. To expedite processing, please provide the information in the format and order described <br />in this form. <br />GENERAL OPERATION LNFO&MATION <br />Type or print clearly, in the space provided, all information described below. <br />1. ApplicanUoperator or comoanv name (name to be used on permit): <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: <br />2. Operation name (pit, mine or site name]: DAMS PIT <br />3. Permitted acreage (new or existing site]: 105.35 permitted acres <br /> 3.1 Change in acreage (+) acres <br /> 3.2 Total acreage in Permit area 105 .35 acres <br />4. Fees: <br /> 4.1 New Application $2.344.00 application fee <br /> 4.2 New Quarty Application $2.906.00 quarry application <br /> 4.4 Amendment Fee $1,938.00 amendment Fee <br /> 4.5 Conversion to ] 12 operation (set by statute) ~ - $2.344.00 conversion fee <br />5. Primary commoditie(s) to be mined: SAND GRAVEL ROAD MATERIALS <br /> 5.1 Incidental commoditie(s) to be mined: I. / Ibs/Tons/vr 2. / Ibslfons/vr 3. / Ibs/I-ons/vr <br /> <br /> 4. / Ibs/fons/vr 5. / Ibs/fons/vr <br /> 5.2 Anticipated end use of primary commoditie(s) to be mined: ROAD MATERIAL <br /> 5.3 Anticipated end use of incidental commoditie(s) to be mined: <br />