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STATE OF COLORf'~DO <br />DIVISION OF RECLAMATION, MINING AND SAFETY <br />Department of Natural Resources <br />1313 Sherman St., Room 215 ~ <br />Denver, Colorado 80203 C O L O R A D O <br />ntvlston or <br />Phone: (303) 866-3567 RECLAMATION <br />PAX: (3031 83 2-87 06 CONSTRUCTION MAT'F,RIALS M I N I N G <br />REGU[.AR (712) OPERATION SA &TY <br />Rh:CI,AbIATION PERMIT APPLICA'CION FORM <br />Bill Ritteq Jr. <br />Governor <br />CHECK ONE: 'there is a File Number Already Assigned to this Operation Harcit D. snerman <br />Executive Dirctikrr <br />Permit # ~ -_ _ _ (Please reference the file number currently assigned to this operati~7~ald tv. cauany <br />New Application (Rule 1.4.5) Amendment Application (Rule L ] 0) Division Director <br />tiatual R~sourc:e Trustee <br />`Conversion Application (Rule 1.11) <br />Petrrtit # M -~-1[~.,-~ (provide for Amendments and Conversions of existing pemvts) <br />The application for a Construction Materials Regulaz 112 Operation Reclamation Peradt contains three major parts: (1) the application <br />form; (2) Exhibits A-S, Addendum 1, any sections of Exhibit G.5 (Geoteclmical Stability Exhibit, and (3) the application fee. When you <br />submit your application, be sure to include one (1) complete sinned and notarized ORIGINAL and one (1) copy of the completed <br />application form, two (2) copies ofExhibits A-S, Addendum i, appropriate sections of6.5 (Geotechnical Stability Exhibit, and acheck for <br />the application fee described under Section (4) below. Exhibits should NO'f be bound or in a 3-ring binder; n7.aps should be folded to <br />8 I/2" X 1 I" or 8 I(2" X 14" size, To expedite processing, please provide the information in the format and order described in this form. <br />GENERAI.OPERAT'ION INFORMATION <br />Type or print clearly, in the space provided, ALL information requested below. <br />1. <br />2. <br />3. <br />4. <br />5. <br />AopiicanUoaerator or comnanv name (name to be used on permit <br />I.I Type of organization (corporation, partnership, etc.): , <br />Operation name (pit, mine or site name): <br />Permitted acreage (new or existine site, j: <br />3.1 Change in acreage (+) <br />3.2 Total acreage in Permit area <br />Fees <br />permitted acres <br />acres <br />acres <br />4.1 New Application $2,696.00 application Fee <br />4.2 New Quarry Application $3,342.00 quarry application <br />d.4 Amendment Fee 52,229.04 amendment tee <br />4.5 Conversion to 2 t2 operation (set 6y statute} S2,696.00 conversion fee <br />Primary commoditie(s) to be mined:.,.`'L; ~h _ / E <br />5.1 Incidental commoditie(s) to he mined: I. - 1bslfons/vr 2. / tbs/Tons/yr <br /> 3. ! IbsrTons/yr 4. `_ / Ibs/Ton <br />s/vr 5. _ ! Ibs/Tonsnn~ <br />5.2 1 <br />An[icipatedenduseofprimarycommoditie(s}tobernined: t-.Oils//y~{IDA1 eKt~R,~ <br />5.3 Anticipated end use of incidental commodities} to be mined: <br />7 7~ I'.~rylC, ~% Lr1t4t/ U'L3I <br />Office of Office of <br />M ned Land Reclamation Denver Grand lunc[ion Durango Active and Inatlive Mines <br />