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,;; l0 DEPARTMENT OF NATURAL RESOURCES <br />y±~ `y Daritl H. Getcr,es, Executive Director <br />`1876' MINED LAND REt~MATION DID <br />DAVID C. SHELTO N, Director. ~' ~ <br />.. ea ~ ~ ~__., <br />"~ <br />PoUartl D. Lamm _- <br />Goremor '1~2 ""' .F y <br />• <br />~~~~ ~~ "REGULAR (112) PERMIT <br />`APPI.IGA130N FORM <br />,. <br />.. <br />Application for Mining and Reclamation Permit, Pursuant to C.R.S. 1973, 34-32-101, <br />et s~ce as amended. ~ 7 / <br />(Type of Print Clearly) <br />1. Name of Operation <br />(pit, mine or site name) <br />2. Name of Applicant/Operator <br />(name to be used on permit) <br />3. Address and Phone Number of <br />Local Office , <br />Peters Gravel Pit No. 2 <br />Weld County, Colorado <br />Weld County - Department of Engineerin <br />P. 0. Box 758 - 915 10th Street <br />Greeley, CO 80632-0758 Phone-303-356- <br />4. Address and Phone Number of <br />General Office I Same as above <br />5. Name and Phone Number of Person <br />Staff Members Should Contact <br />6. Parent Corporation, If Any <br />(include name and address) <br />4750 <br />Donald Carroll, Engineering Dept. 356-4000 ext S75( <br />Kenny Schraeder, Mining Supervisor-356-4000 ext475( <br />John Peters Peters 313 Ranch <br />Carpenter, WYO 82054 <br />7. Owner(s) of Record of Affected <br />Land (surface area) I Same as above <br />(if more than two, list in <br />EXHIBIT P) <br />8. Owner(s) of Substance to be Same as above <br />Mined (if more than two, list <br />in EXHIBIT P) <br />.. <br />423 Centennial Building, 1313 Sherman Street Denver, Colorado 80203 TeI. (30z) 866-3567 <br />