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RECENED <br />JU L ? 7 aaa4 U o D .,~ , ~. - ~ 0.x~.~-coo-~r~ <br />Per ~ ~rz.~ STATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />Department of Natural Resources BETH CUMMINB <br /> COUNTY CLERK & RECORDER <br />t3t3 Sherman St., Room 2t5 221 SO.INTEAOCEAN <br />Denver, Colorado 80203 HOLYOKE, COLORADO 80734 <br />Phone: (3031 866-3567 CONSTRUCTION MATERIALS <br />FAX: (303)832.8106 <br /> LIMITED IMPACT (110) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />CHECK ONE: There is a Fik Number Already Assigned to this Operation <br />Permit # M -_ _ _ (Please reference the £le 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 Yj M - -_ (provide for Amendments and Conversions of existing permits) <br />COLORADO <br />DIVISION OF <br />MINERALS <br />GEOLOGY <br />0.EClAMRION•NININO <br />SAf ETY•SCIENCE <br />Bill Owens <br />Govertror <br />Creg E. Walther <br />Executive Director <br />Ronald W. Cattany <br />Division Direttm <br />Natural Resource Tnntee <br />The application for a Construction Materials Limited Impact (110) Operation Reclamation Perntit corttams three majorparts: (1) the application <br />form; (2) Exhibits A-J, Exhibit L, Addendum 1, any sections of Exhibit 6.5 and Geotechnical Stability Exhibit, as required by the Office, and <br />outlined in Rules 6. ], 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 <br />(I)comoletesi r~tedandnotarizedlVORYORIGINALandone(1)copyofthecompletedlv~applicationfotm,two(2)copiesofEtdtibits <br />A-J, Exhibit L, Addendum ],and appropriate sections of 6.5 (Geotechnical Stability Exhibit), as required, and a check for [he application fee <br />described under (4) below. Exhibits should NOT be bound or in a 3-ring binder, maps should be folded to 8 12" X 11"or 81/2" X 14" size. <br />To expedite processing, please provide the infotrllation 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 bebw. <br />1. AnDlicantlocerator or rnmmanv name (name to be used on cermk): John M, Everit t <br /> 1.1 Type of organization (corporation, paMership, etc.): Individual <br /> 1.2 1.2 I.R.S. Tax ID No. or Social Sectuity Numher: <br />2. OD erationname(Dit.miaeoraitenamel: Everitt Pit <br />3. Permitted acreage (new or ettistinfe site): 9.9 pl;rntitted acres <br />3. I Change in acreage (+) acres <br />3.2 Total Acreage in Permit Area 9 . q acres <br />4. Fees: <br />4. ] New Application: I$ .,094.00 application fee <br /> Amendment Fee (C.R.S. 34-32.5-125(II)): 719.00 application fee <br />4.2 Conversion Fee (from 110d to 110 $875.00 conversion fee (Rule 1.11.2(2)) <br />5. Primary commoditie(s) to be mined: Grave 1 <br />5.1 Incidental commoditie(s) to be mitred: 1. 1 ]bs(fonslvr 2. ! lbs(Tonslvr 3. / ibslTonsPor <br />4. / ]bs/Tons/vr 5. / ]bs/1'ons/vr <br />5.2 Anticipated end use of primary commoditie(s)tobemined: Aggregate for concrete <br />Anticipated end ttse of incidental commoditie(s) to be mined: <br />Office of Office of Colorado <br />Mined Land Reclamation Active and Inactive Mines Geological Survey <br />