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<br />i ~lrOUs {1., I~~M <br />CI-[ECK ONE: There is a File Number Alreadv Assigned to thu Opera n v(,O -5 f/=0 - O/-OI <br />Permit # L(~~1 (Please reference iltc file number curt ^ <br />New Application (Rule 1.4.5) _ Amendment Application (Rule 1.10) <br />~,~~ STATE OF ADO <br />DIVISION OF MINERALS AND GEOL(~CY ~EC a 8 2UQ~ <br />Depaament of Natural Rr~'R459 0 2000 G U <br />1313 Sherman St., Room ~7$ L . <br />Denver. Colorado~Q,il},ln of Minerals and Ceolos~ Division of Minerals and <br />Phone: 1}0}1866-77S5UY'~~11p° NSTRUCTION ivL4TERL4LS <br />FAX: (}031 83 2-8106 REGULAR (112) OPERATION <br />RECLANL*TION PER~iI7' APPLICATION FORM ~ ~t ~,C 3 <br />1~ <br />~~ <br />WIV lS40N ~ <br />MINERAL <br />&- <br />GEOLOG <br />0.ECLA MA710 <br />nINING•snrE~ <br />Bill Qwens <br />~E Walche~ <br />Ezecmrve D'~reaar <br />m¢hael a. Long <br />Oi.ision D~reaor <br />Concersioo Applicauou (Rule 1.1 l) <br />Permit # M -_ _ _ (provide for Amendments and Conversions of existing pemaits) <br />The application for a Construction Materials Regular 112 Operation Reclamation Permit contain, threw major parts: (i) the application form; <br />(2) Exhtbits A-S, Addendum 1, any sections of Exhibit 6.5 (Geotechnical Stability E.xhtbit; and (3) the application fce. When you submit your <br />applicatioq be sure to include one (1) complete sirmed and notarized IVORY ORIGINAL and Four (4) copies of the completed ivy <br />application form, five (~) copies of Exhibits A-S, Addendum 1, appropriate sections of 6.5 (Geotechnical Stability Exlu~bit, and a check for <br />the application fee described under Section (4) below. Exhtbits should NOT be bound or in a 3-ring binder, maps should be folded to <br />8 I/2" X I I" or 8 I/2" X 14" size. To expedite processing, please provide the information in the format and order described in this form. <br /> GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, all information described below. <br />1. AoaGcaot/ooerator or comoanv Dame (name to be used on oermkl: <br />;-d d• N S TD N E ~ <br />Z,vn , <br />1.1 , <br />Type of organization (corporation, patmership, etc.): rn 1^ o n n N I-; n // <br />1.2 I.RS. Tax I.D. No. or Social Security Number: <br />~ I.~ ~ • / ~~) 7 G, a-. - 'a, ~ (~ I S. <br />rr II <br />2. Operation name (pit, mine or site Dame): -~' I~f ~ (n (a/ E ~ .r A n r L1 ~ <br /> <br /> <br />3. Permitted acreage (new or etistine site): (~ ~ p J ~ rOseeted <br />~ 5 <br />permitted acres <br />3.1 `~ <br />Change in acreage (+) acres <br />3.2 Total acreage in Permit area ~.~ _ acres <br />4. Fees : <br />4.1 New Application $2 344.00 application fee <br />4.2 New Quarry Application $2,906.00 quarry application <br />4.4 Amendment Fee $1.938.00 amendment fee <br />45 Conversion to 112 operation (set by statute) $2.344 00 conversion fee <br /> JX <br />1 <br />i. Primarv commoditiefA to be mined: FIDE u. ~d•~ SIriNP <br />5.1 Incidental commoditie(s) [o be mined: I. / IbslCoas/vr 2. / Ibs(Tons/vr 3. / Ibs(Lonstvr <br /> 4. / Ibs/Cons/vr ~. / Ibs/Toos/vr <br />>.2 Anticipated end use of primary commoditie(s) to be mined: L /,1Nn SO AP.E ~ (~, ~ ' /~/'H Q S fn /VE <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: ~,ec lRsp .a F; n n! !_ ; // <br />