REV07172

• Permit No: M1987164
• IBM Index Class Name: Revision
• Doc Date: 7/3/2000
• Doc Name: CONSTRUCTION MATERIALS REGULAR 112 OPERATION RECLAMATION PERMIT APPLICATION FORM
• Type & Sequence: CN1
• Media Type: D
• Archive: No

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' III IIIIIIIillill III ~F COLORADO
DIVISION OF MINERALS AND GEOLOGY 999
Dcpartmem of Natural Resources
I31 3 Sherman Sl, Room 215 ~~~~~~
Denver, Co(orario 80203
Phony. (3031 866J 567 RECEIVE D
FAX: [phone]
DEPARTMENT OF
JUl u 3 2000 NATURAL
CONSTRUCTION MA~'F'uraT.S RESOURCES
REGULAR (112) oPERATio>Bivislon of rotinerals 8 Geo{Ogy kov Romer
RECLAMATION PERMIT APPLICATION FORM Governor
lames S. lornhead
Execuu.e D:recor
br~rhael B. long
Di~isian Dveaur
CHECK ONE: New Application (Rule 1.4.5) Amendment Application (Rule 1.10)
X Conversion Application (Rule 1.11)
Permit # M - 1987 -164 -_ (provide for Amendments and Conversions of existing
permits)
The application for a Construction Materials Regular 112 Operation Reclamation Permit contains
three major parts: (1) the application form; (2) Exhibits A-S, Addendum 1, any sections of
Exhibit 6.5 (Geotechnical Stability Exhibit; and (3) the application fee. When you submit your
application, be sure to include one (1) complete sinned and notarized IVORY ORIGIIUIL and four (9)
copies of the completed Ivory application form, five (5) copies of Exhibits A-S, Addendum 1,
appropriate sections of 6.5 (Geotechnical Stability Exhibit, and a check for the application fee
described under Section (4) below. Exhibits should NOT be bound or in a 3-ring binder; maps
should be folded to 8 112" X 11" or 8 1/2" X 19" size. To expedite processing, please provide
the information in the format and order described in this form.
GENERAL OPERATION INFORMATION
Type or print cleazly, in the space provided, Imo. information requested belox.
1
2
3
AmHlicaatlomerator oz comHan
Connell Resources
1.1 Type of organization
1.2 I.R.S. Tax I.D. No.
ti ( 't
r name (name to be used on Hermit):
Inc.
(corporation, partnership, etc.): Corporation
~r Social Security Number:
O,.pera on name D1 mine or site name): Camilletti Pit
Permitted acreace (new or existiny site):
3.1 Change in acreage (+)
3.2 Total acreage in Permit area
4. Fees
9.1 New Application
9.2 New Quarry Application
4.3 Milling Application (Non-DMO)
9.4 Amendment Fee
4.5 Conversion to 112 operation (set by statute)
9.9 permitted acres
1 1 . 1 acres
21 acres
51.875.00 application fee
52.325.00 quarry application
53.100.00 milling application
51.550.00 amendment fee
51,875.00 conversion fee
5. Prima ry commoditie(s) to be mined: Gravel Sand Fill Material

5.1 proceg se~
Inci ti ) to be ~7L DCA7l: ~. B
~~~Cll~~~'~tr~~`te - ~YclecTA'spTall-//--~~~
ase - 5000 1bs //'COnsY yr
J' _ ~-
2. B ase / 000 lbs _ on yr 3. ~ /~ lbs/Tons/vr
9. / lbs/Tons/vr 5. / lbs/Tons/vr
5.2 Anticipated end use of primary commoditie(s) to be mined: COriStruCtion/Roa%I&PUlld
5.'3 Anticipated end use of incidental commoditie (s) to be mined: Road Base Material