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<br />~ III IIIliiillllll III `~ ~$~°~ <br />Qcc{n~' I ~ 09 <br />~~1~~ ~ of coLOrz~Do <br />^IVISION OF MINERALS AND GEOLOGY <br />Dr•panmenl of Nannal Resources <br />111 1 Sherman St.. Rnum ? 15 <br />Dencer. Colorado NU2U3 <br />Phone: IIUJI 9fiGJ.5n7 <br />FAx (1031 H 1'-~ll I OG <br />~~~0 <br />~FN ~ 3 X000 <br />JP <br />~~ <br />DIVISION OF <br />MINERALS <br />CONSTRUCTION MATERIALS <br />REGULAR(I12)OPERATION Iv\5•ot\ol~a~ter'l4 <br />RECLAMATION PERMIT APPLICATION FORM <br />GEOLOGY <br />R E C [AMA 7 1 0 N <br />MININ G•SAFETY' <br />eau owero <br />Governor <br />CreF E. Walchc~ <br />E.ecwrve Dvenur <br />CHECK ONE: New A lication Rule 1.4.5 Amendment A lication Rule 1.10\"ichael e. tn~G <br />- PP ( ) PP ( UivRiOO Dlreanr <br />~_ Conversion AppGcarion (Rule I.I I) <br />Permit k til -Z~q SR -_ (provide for Amendments and Conversions of existing permits) <br />The application for a Construction Materials Regular 1 l2 Operation Reclamation Permit contains three major parts: (1) the application forth; <br />(2) Exhibits A-S, Addendum I, any sections of Exhibit 6.5 (Geotechnical Stability Exhibit; and (3) the application fee. When you submit your <br />application, be sure to include one (I) complete simted and notarized IVORY ORIGINAL and four (4) copies of the completed Ivory <br />application form, five (5) copies of Exhibits A-S, Addendum 1, appropriate sections of 6.5 (Geotechnical Stability Exhibit, and a check for <br />the application fee described under Section (4) below. Exhibits should NOT be bound or in a 3-ring binder; maps should be folded to <br />8 1/2" X I 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 />GENERAL OPERATION INFORMATION <br />Type or print clearly, io the space provided, ALL information requested below. <br />AA~olicant/ooera[or or comoanv name (Dame to be used o0 oermitl: Colorado City Metropolitan District <br />I.I Type of organization (corporation, partnership, etc.): Metropolitan District <br />1.2 I.R.S. Tax i.D. No. or Social Security Number: <br />2. Operation name (pit, mine or site name <br />3. Permitted acreaee (new or existine site): permined acres <br />3.1 Change in acreage (+) ~t _ 1 4 acres <br />3:L Total acreage in Permit area (~ A7 1 d acres <br />4. Fees: <br />4.1 New Application <br />4.2 New Quarry Application <br />4.3 Milling Application (Non-DMO) <br />4.4 Amendment Fee <br />4.5 Conversion to 112 operation (set by statute) <br />5. Primary commoditie(sl to be mined: Sand Gravel _ <br />5.1 Incidental commoditie(s) to be mined: I. ,_p_ - Ibs/fons/yr <br />3. / Ibs/i'ons/vr 4. / Ibs/fons/vr <br />$1.875.00 application fee <br />$2.325.00 quarry application <br />$3.100.00 milling application <br />I 0.00 mendment fee <br />{ 875.00 'conversion ee <br />~ / Ibs(I'ons/vr <br />5. / Ibs~i'ons/vr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: _ <br />5.3 Anticipated end use of inciden[a1 commoditie(s) to be mined: <br />