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TATE OF COLOIZf~LDO <br />DIVISION OF MINERALS AND G~(3GY ~ ~ . .. <br />Department of Natural Resources 0/~ury18~ .. _ E7Elr ~al iafED <br />7313 Sherman St., Room 215 /p////~ ~1~~6~~~~~ <br />Denver, Colorado 80203 UUU v o/`T "1 ~ rff1M / <br />Phone: (303) 866-3567 l• L LWJ <br />fA%: (303) 832-8106 <br />Division of Minerals and Geolosy <br />CONSTRUCTION MATEBIALS <br />REGULAR (112) OPERATION <br />RECLAMATION PERMTl' APPLICATION FORM <br />CHECK ONE: There fs a Ft7e Number Already Assigned to this Operation <br />Permit # M -_ -_ (Please reference the Sle number currently assigaed to this operation) <br />R New Applicatiw (Rule 1.4.5) <br />_ Amendment Applicatiw (Rule 1.10) <br />Conversion Applicatiw (Rule 1.11) <br />N~- 2003 - b f I <br />Permit # M -- _ (provide for Amendments and Conversions of existing permits) <br />DIVISION O F <br />MINERALS <br />GEOLOGY <br />RECLAMATION <br />MI NING•SA FETY <br />E~ill Owens <br />Governor <br />Greg E. Walther <br />Executive Director <br />F;onald W. Cattany <br />Acting Division Director <br />The applicator for a Construcfion Materials Regular 112 Operation Reclamation Permit contains three major parts: (1) the applicatiw form; <br />(2) Exhrbits A-S, Addendum 1, any sectiens of Exhrbit 6.5 (Geotechnical Stability Exhibit and (3) the applicator fee. When you submit your <br />applicatoq be sore to include we (1) complete siffied and notarized IVORY ORIGINAL and we (1) copy of the completed I~~ applicatiw <br />form, two (2) copies of Exhibits A-S, Addendum 1, appropriate sections of 6.5 (Geotechnical Stability Exhibit and a check far the applicatiw <br />fee descnbed nnder Section (4) below. Exhibits should NOT be bowl ar ie a 3-ring binder; maps shoold be folded to 8 12" :{ 11" or R 1/2" <br />X 14" size. To expedite processing, please provide the information in the format and order descrrbed in this form. <br />GENERAL OPERATION INFORMATION <br />Type or prier clearly, in the space provided, ALL ieformatioe requested below. <br />1. AnolicanUooerator or comnaev name (name to be need on cermftl: L a i a r ~ e id e s t , Inc . / <br />] .1 Tvpe of organizatiw (corporation, partnership, etc.): C o r p o r a t i o n <br />1.2 I.RS. Tax I.D. No. of Social Security Number: <br />2. Ooeration same (ek. mine or site Hamel: Du C kw0 r t h P 1 t r! <br />3. Permitted acreage (new or existing site): <br />3.1 Change in acreage (+) <br />3.2 Total acreage irr Permit area <br />4. Fees <br />56.5 permitted ages <br />acres <br />56.5 acres <br />4.1 New Applicatiw $2,344.00 application fee <br />4.2 New Quarry Application $2 906.00 quarry application <br />4.4 Amendment Fee 51.938.00 amendmeatfee <br />4.~ Conversiw to ] 12 operation (set by statute) 52,344.00 conversion fee <br />5. Primarycommoditie(sltobemined: sand gra vel fill material <br />5.1 Incidental commoditie(s) to be mined: i. N - A Ibs/Tws/ yr 2. / Ibs/Tws/~r <br /> 3. / Ibs/Tonslvr 4. / Ibs/Tons/v r 5. / 1bs/Toasl~r <br />5.2 Anficipated end use of primary commoditie(s) to be mined: C o n s t r u c t i o n i4 a t e r i a l s <br />5.3 Anticipated end nse of incidental commoditie(s) to be mined: N / A <br />