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//~,%~~ ~~~r~z~ ~ CENED <br />l~/"~ J SEP 2 p 2067 <br />CONSTRUCTION MATERIALS ~ a9 and%~on, <br />REGULAR (112) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />CHECK ONE: There is a File Number Already Assigned to this Operatioa <br />Petmit # M -~- //2 -_ (Please reference the file number currently assigned to this operation) <br />_ New Application (Rule 1.4.5) _ Amendment Application (Rule I.10) <br />Conversion Application (Rule I.1 I ) <br />Permit # M -_ -_ (provide for Amendments and Conversions of exisring permits) <br />The application for a Construction Materials Regular 112 Operation Reclamation Permit contains three major pans: (I) the application <br />form; (2) Exhibits A-S, Addendum 1, any sections of Exhibit 6.5 (Geotechnical Stability Exhibit; and (3) the application fee. When you <br />submit your application, be sure to include one (1) complete sianed and notarized ORIGINAL and one (1) copy of the completed <br />application form, two (2) copies ofExhibits 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. Exhibits should Q be bound or in a 3-ring binder; maps should be folded to <br />8 112" X 11" 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, in the space provided, ALL information requested below. ~~Y~ <br />I. AppIICBnt/ODeratpr Or COmpanV name (name tp be USed On permit): ~L7 t ~a'PI^.S /~P AY .QLt ~-P !ie? .IG//C <br />1.1 Type of organization (wrporation, pamtership, etc.): <br />2. Operation name (pit, mine or site Hamel: ~~ ~ ~L~r.- < ry q ct rp q G ~- E'- ~ ~l~L~ <br />~--' <br />3. Permitted acreaee lnew or xistine tel: <br />3.l Change in acreage (+)'-' <br />3.2 Total acreage in Permit area <br />~_ permitted acres <br />jf0, r+y°x9- acres <br />3 9, 3~ 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) 52,344.00 conversion fee <br />I <br />5. Primary eommoditlefsl to be mined:~~„a <br />5.1 Incidental commoditie(s) to be mined: I. - Ibs/1'ons/vr 2. / lbslTons/vr <br />3. 1 Ibs/Tons/vr 4. / lbslfons/vr 5. / Ibs/Tons/vr <br />5.2 Anticipated end useofprimarycommoditie(s)tobemincd: ~~Fn?vczl ~nn5~ritc--~-~ni1 ~~DYI[rf_fF <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: _~~A <br />