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~_~-~~ <br />STATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />Department of Natural Resources R~C~I'V~~ <br />1313 Sherman St., Room 215 1l1•. <br />Denver, Colorado 80203 FILE C 0 P Y <br />Phone: (303) 866-3567 <br />FAX: (3 031 832-81 06 f pR SCANIV/N~i ACT (~ 2 X003 <br />Division of Minerals and Geslopy <br />CONSTRUCTION MATEBIALS / <br />REGULAR (112) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />GENERAI.OI'ERATION INFORMATION <br />Type or print clearly, in the apace provided, AI,L information requested below. <br />CHECK ONE: There is a Foe Number Already Assigned to this Operation <br />Permit # M -_ _'- (Please reference the file number currently assigned to this operation) <br />New Application (Rule 1.4.5) /Amendment Application (Rule 1.10) <br />Conversion Apglication (Rule 1.1 I ) <br />Permit # M -2~0 lI - 0 8 S- ~ (provide for Amendme>ota and Conveniona of ex;c~; pennita) <br />DIVISION O F <br />MINERALS <br />GEOLOGY <br />RECLAMATION <br />MI NING•SAFETY <br />sal Owens <br />Governor <br />Greg E. Wakher <br />Executive Director <br />Ronald W. Cattany <br />A<ting Division Director <br />The application for a Constriction Materials Regular 112 Operation Reclamation Perffit rnntains three major parts: (I) the application form; <br />(2) Exhibits A-S, Addendmm 1, a~ sections of Exlnbit 65 (Geoteclmioal Stability Exhibit; and (3) the application fee. When you submit your <br />applicatioq be sole to include one (1) complete sieaed and notarized IVORY ORIGINAL and one (1) copy of the completed I~ application <br />form, two (2) copies of Exhibits A-S, Addendum 1, appropriate section of 6.5 (C.eotechmical Stability Exhibit, and a check for the application <br />fee rlesenbed under Section (4) below. Exhibits shonld~T_ be bound or in a 3-ring binder, maps should be folded to 812" X 11" or 8 I/2" <br />X 14" size. To expedite processing, phrase provide the information in the format and order descnbed is this form. <br />ba <br />2. Operation name (pit, mine or site namel: ~z-4~ ~~`t'~ `-"`r` `~ `i~` d ~rnvt.~ l "'"~ <br />3. Permitted acreas?e (new or evstina site): <br />~ ~ • ~ permiued acres <br />3.1 Change in acreage (+) 7 ~ (e acres <br />3.2 Total acreage in Permit area $3 . I acres <br />4. Fees <br />4.1 NewApplicaIIOn $2,3•k1.00 appficationfee <br />4.2 New Quarry Application $2.906.00 gamry application <br />4.4 Amendment Fee $I-938.00 amendmcatfee~ <br />45 Conversion to 112 operation (set by statute) $2.344.00 conversion fee <br />5. Prim ary commoditie(sl to be mined: ~-~^ ~- ~~-~^-~ °f r'H.v ~ I - <br />5.1 Incidental commoditie(s) to be mined: 1. Ibs/Tons/vr 2. ! Ibs/Cons/vr <br /> 3. / lbs/Tons/vr 4. / Ibs/Tons/vr 5. / 1bsrTons/vr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: eo'^ 5'{''",..~-h.... Q~ re5 ri'~- / !^o t~- b r~se <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: A3 ~ <br />1.2 I.IiS. Tax I.D. No. or Social Security Number: O ~ - 36 3 Y 3 <br />