2004-06-18_PERMIT FILE - M2004037

• Permit No: M2004037
• IBM Index Class Name: Permit File
• Doc Date: 6/18/2004
• Doc Name: 110c Appl Pkt
• From: John M. Everitt
• To: DMG
• Media Type: D
• Archive: No

STATE OF
DIVISION Of MINERALS AND GEOLOGY
Deparnnent of Natural Resowces
1313 Sherman St., Room 275
Denver, Colorado 80203
Phone; [phone] CONSTRUCTION MATERIALS
FAX: [phone]
LIMTI'ED IC•ILPAGT (110) OPERATTON
RECLAMATION PERMIT APPLICATION FORM
/LI aoO ~/^ C7 3 7
JUN 18 2004 c o L o xA~
~IYISlenet DIV IatDN OF
Minerals & Ceo ~I N S RA L S
GEOLOGY
0.ECLANATION•NIN LNG
SAf ETT•SCIENCE
Bill Owens
Governor
CHECK ONE: There is a File Number Already AasigrEed to this Operation
Greg E. Walther
Executive Director
Petmit # M -~~ (Please reference the file number currently assigned to tlris operation) Ronald W. canany
Division Director
XX New Application (Rule 1.4.5) Amendment Application (Rule 1.10) Natural Resource Trustee
Conversion Application (Rule 1.11)
Petmit # M -^ -_ (provide for Amendments and Conversions of existing permits)
The application for a Construction Materials Limited Impact (I IO) Operation Reclamation Permit contains three majorpatts: (1) the application
fomt; (2) Exhibits A-J, Exhibit L, Addendum I, any sections of Exhibit 6.5 and Geotechnicai StabiliTy Exhibit, as required by the Office, and
outlined in Rules 6.1, 6.2, 6.3, 6.5, and 1.6.2(I)(b); and (3) the application fee. When you submit your application, be sure [o include one
(1) complete sieved and notarized IVORY ORIGINAL and one (1) copy of the completed IVON application form, two (2) copies of Exhibits
A-J, Exhibit L, Addendum ],and appropriate secions of 6.5 (Geotechnical Stability Exhibit), as required, and a check for the application fce
described under (4) 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 14" size.
To expedite processing, please provide the information in the format and order described in [his form.
GENERAL OPERATION INFORMATION
Type or print clearly, in the space provided, ALL informatioe described bebw.
1. A~plicantlocerator or comoanv name (Dame to be used on tmrmR): John M. Everitt
1.1 Type oforganization(cotporation,partrLership,etc.): Individual
1.2 1.2 I.R.S. Tax ID No. or Social Security Number:
2. ODerationDame(Dit.mioeorakenamel: Everitt Pit
3. Permitted acrealte (new or e7tistin7! aitel:
3.1 Change in acreage (+)
3.2 Total Acreage in Peralit Area
4. Fees:
4. ] New Application:
Amendment Fee (C.R.S. 34-32.5-125(II)):
4.2 Conversion Fee (from 110d to 110 75.00 conversion fee (Rule 1.11.2(2))
5. Primary rnmmodRle(s) to be rained: Grave 1
acres
9.9 saes
1 094.00 application Fee
719.00 application fee
5.1 Incidental commoditie(s) to be mined: ]. / lbs/fons/vr 2. / ]bs/Tons/vr 3. / Ibs/1'ons/vr
4. / Ibs/fons/vr 5. / Ibs/Tons/vr
5.2 Anticipated end use of primary commoditie(s)toberitined: Aggregate for concrete
Anticipated end use of incidental commoditie(s) to be mined:
9.9 permitted acres
Office of Office of Colorado
Mined Land Reclamation Attive and InaRive Mines Geological Survey