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3a8 ~ ~ r438.co <br />STATE QF CUL~RADO <br />DIVISION OF MINERALS AND GEOLOGY ~(~~ CI'IP~'' RE~~g4~~D ~'~ <br />Department of Natural Resources 1 ~~ jj A <br />1373 Sherman St., Room 215 ~®D ~~/~ AeA~/~~ [' y~°" D 1 v 1 5 I o N O <br />Denver, Colorado 80203 (i /7L/~//~!lldAA 1- F~. ~ '~1 I [N E IZ/~ I. ; <br />Phone. (303j 865-3567 ~~ ~ ~u , <br />FAX: (303) $32-8706 Division of Minerals G E O L O G 1 <br />and Geofag <br />CONSTRUCTION MATERIALS M EN I N GM S A FI ° 7 i <br />REGULAR (112) OPERATION / <br />RECI.-Al~IATION PERMIT APPLICATIO\' FdR'~1 V Sill ovens <br />Governor <br />Greg E. \', archer <br />`_necueive Dnecror <br />CHECK ONE: _ New Application (Rule 1.4.5) X Amendment Application (Ru[e I.IO) Michael a. ! ong <br />Division Director <br />Conversion Application (Rule 1.11) i <br />Petvut # M -~_- 0 3 4_-_ (pro~ride for Amendments and Conversions of eacisting permits) <br />The application for a Construction Materials Regular 112 Operation Reclamation Pemut contains three major parts: (1) the applicaton form; <br />(2) Exhibits A-S, Addendum 1, anY sections of Exhibit 6.5 (Geotechnical Stability Exhibit; and (3}the application fee. 4y'hen you submit your <br />application, be sure to include one (1) come sued and notarized IVORY ORIGINAL and foty (4) copies of the completed No <br />application form, five (5) copies of Exhibits A-S, Addendum 1, appropriate sections of 6.5 (Geotechnicat Stability Exhibit, and a check for <br />the application fee described under Section (4) below. Exbibits should NOT be bound or in a 3-ring binder; maps should be folded to <br />8 1/2" X 11" or 8 1/2" X 14" size. To expedite processing, please provide the infotmafion in the format and order described in this form. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the apace provided, ALL Information regnested below. <br />1. A~„plicsnUoperatororcomoanynamefnametobeusedonnermifl: A4dregate Industcxries - WCRr Ttlr. <br />1.1 Type of organization (corporation, partnership, etc.): An Indiana Corporation <br />1.2 I.RS. Tax I.D. No. or Social Security Nnmber: <br />2. Ooerationname(nit.mineorsitenamel: Cooley Reservoir and Fulton Wildlife Area / _ <br />3. Permitted acreage (new or existing site): 3 4 8. 9 6 permitted acres <br />3,1 Change in acreage (+) 5 0.21 acres <br />3.2 Tots! acreage in Permit area 3 9 9 - 1 7 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 />5. Primarvcommoditie(sltobemined: Sand Gravel Borrow <br />5.1 Incidental commoditie(s) to be mined: L (; 01 d - 1 2 lbs/Tvnzdvr 2. / 1bs/Tons/vr <br />3. / lbs/Tovs/vr 4. / lbs/Tans/yr 5. / lbs/T'ons/yr <br />5.2 Anticipated end use ofprimary commoditie(s)to be mined: Road and Hi ahwav Cone rinYi on <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: NA <br />