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=_ .f - <br /> <br />STATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />Department of Natural Resources Q <br />1313 Sherman 5[., Room 215 ° ,~CE~`/L® <br />Denver, Colorado 80203 v C <br />Phone: (303) 866-3567 T <br />FAX: (303) 832-8106 OCT' 7 ~~2 / <br />CONSTRUCTION MATERIALS Division of Minerals and Dealogy <br />~~ REGULAR (112) OPERATION <br />®~ ~ PERMIT APPLICATION FORM) <br />CHECK ONE: _ New Application (Rule 1.4.5) <br />X Conversion Application (Rule 1.11) <br />DIVISION OF <br />MINERALS <br />GEOLOGY <br />RECLAMATION <br />MI NING•SA FETY <br />BiII Owens <br />Governor <br />Greg E Walther <br />Executive Director <br />Amendment Application (Rule 1.1 ¢hael B. Long <br />ivision Director <br />Permit # M - 78 _ 192/ (provide for Amendments an Conversions f exisfing permits) <br />The applicaion for a Construction Materials Regulaz 112 Operaton Reclamation Permit contains three major parts: (1) the application form; <br />(2) Exhibits A-S, Addendum 1, any sections of Exhibit 6.5 (Geotechnical Stability Exhibit; and (3) the applicafion fee. When you submit your <br />application, be sure to include one (1) complete sivned and notarized IVORY ORIGINAL and four (4) copies of the completed IV62V <br />applicaion form, Five (S) copies of Exhibits A-S, Addendum 1, appropriate sections of 6.5 (Geotechnical StabilityExhibi[, and a check for the <br />application fee described under Secfion (4) below. Exhibits should NOT be bound or in a 3-ring binder; maps should be folded to 8 1/2" X 11" <br />or 8 1/2" X 14" size. To expedite processing, please provide the informaflon in the format and order described in this form. <br /> GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, ALL information requested below. <br />1. An plicant/oaerator or company name (name to be used on permit): OiAFFEE CWN 1R / <br /> 1.1 Type of organization (corporation, partnership, etc.): (~VERAAIENT EPICTTY <br /> 1.2 LR.S. Tax LD. No. or Social Security Number: <br />2. Op eration name (pit, mine or site Hamel: CIRCLE 23 PIT / <br />3. Permitted acreaee (new or existing site): 8 permitted acres <br /> 3.1 Change in acreage (+) +12 acres <br />- 3.2 Total acreage in Permit area 20 acres <br />4. Fees: <br /> 4,1 New Application $2.344.00 application fee <br /> 4.2 New Quarry Application $2.906.00 quarry application <br /> 4.4 Amendment Fee $1.938.00 amendment fee <br /> 4,5 Conversion to 112 operation (set by statute) * $2.344.00 conversion fee <br />S. Primary commoditie(s) to be mined; ($2AVE7. <br />S.1 Incidental commodite(s) to be mined: 1. - lbs/Tons/vr 2. / lbs/I'ons/vr <br />3. / lbs/Tons/vr 4. / lbs/I'ons/vr S. / lbs/pons/vr <br />5.2 Anficipa[ed end use of primazy commoditie(s) to be mined: ROAD &9.SE FOR COTlN1Y ROADS <br />5.3 Anficipated end use of incidental commodite(s) to be mined: <br />