PERMFILE68703

• Permit No: M1999003
• IBM Index Class Name: Permit File
• Doc Date: 1/27/1999
• Doc Name: CONSTRUCTION MATERIALS LIMITED IMPACT 110 OPERATION RECLAMATION PERMIT APPLICATION FORM
• Media Type: D
• Archive: No

DIVISION OF MINERALS AND GEOLOGY
Dcpanmem of Natural Resources
1313 Sherman St.. Room 215
Dcnvcr, Colorado 80203
I'honc: (3031 86G-3567
FAX:[phone]~BIU8
STATE OF COLORADO
R~rFI\!F I`'
JAh 2'1 1999
Division of Minerals +~ ~eo1o9y
~mvurar.g
LIIZITED II~ACT (110) OPERATION
RECLA29~TION PERMIT APPLICATION FORM
i
DEPARTMEIv'T O&'
NATURAI.
RESOURCE`.:
Rov Romer
Governor
Tames S. Lochhead
Eaecurlve Dvecmr
M1rKhael B. Long
CHECK ONE: _~ New Application (Rule 1.9) Conversion Application (Rule 1.11) D~.~~:ion Director
Amendment Application (C.R.S. 34-32.5-110)
Permit # ~- -1 -1 -~-_ (provide for Amendments and Conversions of
existing permits)
The application for a Construction Materials Limited Impact (110) Operation Reclamation Permit
contains three major parts: (1) the application form; (2) Exhibits A-J, Exhibit L, Addendum 1,
any sections of Exhibit 6.S~and Geotechnical Stability Exhibit, as required by the Office, and
outlined in Rules 6.1, 6.2, 6.3, 6.5, and 1.6.2(1)(6); and (3) the application fee. When you
submit your application, be sure to include one (1) complete sinned and notarized IVORY ORIGINAL
and one (1) copy of the completed Ivory application form, two (2) copies of Exhibits A-J,
Exhibit L, Addendum 1, and appropriate sections of 6.5 (Geotechnical Stability Exhibit), as
required, and a check for the application fee described under (9) below. Exhibits should NOT be
bound or in a 3-ring binder; maps should be folded to 8 1/2" X 11" or 8 1/2" X 19" size. To
expedite processing, please provide the information in the format and order described in this
form.
GENERAL OPERATION INFORMATION
Type or print clearly, is the space provided, si•r• information described below.
1. Applicant/operator or campaav name (name to be used on permit):
Jerald A, Seifert and Fred Lowry, Tenants In Common
1.1 Type of organization (corporation, partnership, etc.):
1.2 I.R.S. Tax ZD No. or Social Security Number: 84-06-776-55
2. Operation name (pit• mine or site name): Tallahassee Pit
3. Permitted acreage (nex or existing site):
3.1 Change in acreage (+)
Total Acreage in Permit Area
permitted acres
acres
acres
4. Fees•
9.1 New Application 875.00 application fee
Amendment Fee (C.R.S. 39-32.5-I25(II)) 5 575.00 application fee
9.2 Conversion Eee (from 110d to 110 BS 75.00 conversion fee (Rule 1.11.2(2))
5. Primar y commoditie(s) to be mined: Sand Gravel
5.1 Incidental commoditie(s) to be mined: 1. _0_ lbs/Tons/vr
2. / lbs/Tons/vr 3. / lbs/Tons/vr
9. / 1bs/Tons/vr 5. / 1bs/Tons/vr
5.2 Anticipated end use of primary commoditie(s) to be mined: ConstrUCtion
5.3 Anticipated end use of incidental commoditie(s) to be mined: -0-
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