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STATE O~CC <br />DIVISION MINERALS AND GEOLOGY <br />Department of Dural Rewurtes R~eJv~ <br />131) Sherman t, Raom 215 <br />Oemer, CClur 080203 NOV 1 <br />Phxe: (303.8 •7567 <br />fA7l: uo3, e32.;n1ob 1999 <br />coxsTntTC-r1oN w-ratiu.sn f~e'~ba Leo <br />1tlOCLllll (111) OP)DlJ1TION ~ <br />1liCL111D1TI0N P><1tlIIT AAPLIGTION ~011l1 <br />Roy Roma <br />Go~ernar <br />pmts S lahhrod <br />E.ecut~ve D~~ata <br />M~cnxl s loy <br />Dig if~on DirKta <br />CHECK ONE; '_ Nar Application (Rul• 1.4.5) R Amaadmaat Applieatiw~ (Rul• 1.10) <br />~_ Coawrsioa Application (Rule 1.11) <br />Pszmit N H. _ 77 _ 105 __ (provid• for Aaeadasat• and Cobvarsioaa of <br />existing permits) <br />The application. for a Construction Materiels Regular 112 Operation Reclamation PR~rmit contains <br />three major parts: (1) th• application form; (2) Exhibits A-S, Addendum 1, an• sections of <br />Exhibit 6.5 (G oteehnieal Stability Exhibit; and (3) the application las. when y u submit your <br />application, b~ aura to include one (1) complete s?aped and not V 1t 1ti4I and four (4) <br />copies of the ompleted application ozm, five !5) coy a of Exh airs A Addendum 1, <br />appropriate ae lions of 6. (Gaotechnical Stability Exhibit, and a cheek for the application fee <br />described undo Section (4) below. Exhibits should ~; b• bcund or in a 3-ring binder; maps <br />should bs fold d to 8 1/2" X 11" or 8 ]/2" X 16" size. To axpedit• processing, G~leass provide <br />the inforlratior in the format and order fleseribed in this form. <br />•ssssusauau~ suss:esuusauuuau usu•ussssauso sassaasuuusasau ss s••+s asaa•essss <br />GENERAL OPERATION INFORMATION <br />Type a pslat clauly, is iha apace provided, 1,~ ialoraetioa requested b~loM. <br />•uaasu usu^ ^usaaoas oases usu ss r.ususs ss^aaaassusuausa~ssusssasusus~sas•:eu s:• <br />1. O O Y • <br />T V i <br />1.1 • of organization (corporation, pnztnership, etc.):IndlVldual f,a,~nily Operation <br />1.2 I...5. Tax I.D. No. or Social Security Numbez: <br />2; • a SRI COUNTY GRAVEL <br />3, p r o sits) ~ 2fi.13 pe a.itted acres <br />3.1 Ch ngs in acreage (+ or -) 115 _ f ~ acres <br />3.2 To :el acreage in Permit area 141.13 ~ acres <br />i <br />4 ~~~ Ne Application 51.875.OD n plicatior. Lae <br />4.2 Ns Quarry Application 52.325.OD q>lar applies=ion <br />4.3 Mi ling Application (Non-DMO) 53.100.00 milli q application <br />4.4 Am ndment Fee 51.550.00 amendment fee <br />4.5 Cozvezsion to 112 operation ;set by statute) 51,875.00 donvaraion fee <br />i <br />5. Pr - ~oditie(s) to be mined:~yvr r - <br />5.1 In~identnl commoditie(s) to be mined: 1. NONE - lbs/Toe#/vr <br />2, / lbs/Tons/vz 3. <br />4. / lbs/Toga/vr 5. <br />5.2 Arjticipaced end use of Drimary commoditie(s) to bs mined: G NONE <br />5.3 A,'Itieipat•d end use of incidental eomr..oditie(s) to be mined: <br />pa y~ <br />