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STATE QF C~LOIZADQ <br />DIVISION OF MINERALS AND GEOLOGY ~e+, <br />Department of Natural Raourca Rfi~~i" j~ <br />13135herman St., Roan zls - ~ ~=~~ COLORADO <br />Denver, Colorado 80203 JUL D I V I S I O N O F <br />Phone: (303) 866.3567 CONSTRUCTION MATERL,LS 2) 2005 M I N A RA L S <br />FAX: (303) g32ato6 REGULAR (112) OPERATION •;+I~i:,~;. G E O L O G Y <br />>rt :'-"5 x. ~; ~,.7 RFOIANATION•NININO <br />RECLAMATION PERMIT APPLICATION FORM df0 snrarT•seleNCa <br />Bill Owms <br />Governor <br />S,11ECK ONE: There is a File N»mber Already Assigned to this Operation <br />Russell George <br />Permit # M -_-_ - (Please reference the file number ctnrentty assigned to this operation) ExeMive DireROr <br />_ New lication ule 1.4.5) _ Amendment A lication ule 1.10 Ronald w. catany <br />APP (R PP (R ) Division Dinxtor <br />Converabn Application (Rule 1.11) Nmunl Resource Trustee <br />Permit # -„ vLi _-~~-~ (provide for Amendments end Conversloos of existing petwits) <br />The application for a Construction Materials Regular 112 Operation Reclamation Permit contains three majprparts: (1) the application form; <br />(2) Exhibits A-S, Addendum 1, a~ sections ofExhibit 6.5 (Geotechnical Stability Exhbbit; and (3) the application fee. Whey you submit your <br />application, be sure to include one (1) complete signed and notarized ORIGINAL and one (1) Dopy ofthe completed applicatioafarm,two (2) <br />copies ofExhrbits A-S, Addendum 1, appropriate sections of 6.5 (Geote6hnical Stability Exhibit, and a check for the application fee desrnbed <br />under Section (4) below. Exhibits should NO be bolmd or in a 3-rirrgbinder; maps should be folded to 8112" X I ]" or 8112" X 14" s¢e. To <br />expedite processing, please provide the information in the format and wader degcrrbed in this form. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, ALL httormrttion requested below. <br />Type of orgapization (corporation, P~~R ~-)~ <br />2. Operation name (pit, mine or ske name): <br />3. Permltted_urca¢e (new or existing site): <br />3.1 Change in atxeege {+) <br />3.2 Tots) azxeage in Permit area <br />4. ~: <br />4.1 New Application <br />4.2 New Quarry Application <br />4.4 AmepdmentFee <br />4.5 Conversion to 112 operatioD (set by statute) <br />S. Prhnarv commodfNe(al to 6e mined: r V Q.` <br />5.1 Incidental commoditie(s) to be mined: 1. ]bslfons/y!: <br />Ia^,~,°p Permtttedacres <br />sees <br />7 ~ C ~ ~ ~=1 acres <br />$2.344.00 application fee <br />$2.906.00 quarry application <br />$1.938.00 amendmentfce <br />2 3 conversion fee <br />2. / lbsll'onsWr <br />3. / ]bs/Toas/vr 4. / 1bsR'ons/yr 5. // Ibs/fons/vr <br />5.2 Anticipated end use ofprimary commoditie(s) to be mined: l I~iYI~~+( ll f ~"1 ~ t'1 ~iC~O~d <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: <br />Office of Office of Colorado <br />Mined Land Redamatinn Ann.. ,,.d m~.'n..n ul,.~ r...l.._:_-r e.._._ <br />