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~~~ <br />DIVISION OF MINERALS AND GEOLOGY <br />Department of Nawra( Resources <br />1373 Sherman St., Room 215 <br />Denver, Colorado 80203 <br />Phone: (303) 866-3567 <br />FAX: (3031832-8706 <br /> <br />~".', 0 ~ cCD5 <br />DIVISION O F <br />MINERALS <br />~-OLOGY <br />RECLAMATION <br />MIN ING•SAFETY <br />CONSTRUCTION MATEBIALS <br />REGULAR (112) OPERATION <br />RECLAMAITON PERMIT APPLICATION FORM <br />CHECK ONE: ~_ There b a Foe Number Already Assigned to this Operation <br />Permit # 3' - ~ (Please reference the h1e number ctnrently assigned to this operation) <br />_ New App shun (Role 1.4.5) _ Amendment Application (Rule 1.10) <br />Conversion Application (Rule 1.11) <br />Permit # M •~Q$2- 4~-_ (provide for Amendments and Conversions of existing permits) <br />Bill Owens <br />Governor <br />Greg E. Walther <br />Executive Director <br />Ronald W. Cattany <br />Acing Division Director <br />The application for a Constmction Materials Regular 112 Operation Reclamation Pemrrt contains three majorparts: (1) the application form; <br />(2) Exhibits A-S, Addendmn 1, any sections ofF,xhibit 6S (Geotechnical StabrlityF.xiubit; and (3) the application fee. When yon submit your <br />application, be sure to include one (1) complete signed 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 sections of 6.5 (Geotechnical Stability Exhibit, and a check for the application <br />fee descn'bed under Section (4) below. Exln'bils shanld NOT be bound or in a 3-ring binder; maps should be folded to 81/2" X 11" or 8 1/2" <br />X 14" size. To expedite processing, please provide the information yr the fo®at and wader descnbed in this foffi. <br />GENERAL OPERATION INFORMATION <br />Type ar print clearly, in the apace provided, ALL information requested below. <br />I. <br />1.1 Type of orgamzatian (corporation, parliership, etc.): Ldun7u (~GYI'P~n a»E~Gf <br />rr ~-' <br />1.2 I.RS. Tax I.D. No. or Sceial Secrsity Number: t--~o .~ ~~ d)(~ . ~~ ~UO7K2 <br />2. ODeration name fnit, mine or site nameh: ~ G~ ~~D f i .•~a (-~ r'a~JE'~ P <br />3. Permitted acreage (new or ezistins siteh: <br />3.1 Change in acreage (+) <br />3.. Total acreage in Pemtit area <br />4. Fees: <br />4.1 New Application <br />4.2 New Quarry Application <br />4.4 Amendment Fee <br />45 Conversion to 112 operation (set by statute) <br />5. Primary comnrod'rtie(sl to be mined: •~kM~ ~ rCtUCC _ <br />5.1 Incideotai commoditie(s) to be mined: 1. Ibs/fonsl~ <br />3. / Ibs/Tons/vr 4. / Ibs/Tonshr <br />5.2 Anticipated end »se of primary commoditie(s) to be mined: <br />~ aCJ r6/ <br />STATE OF COLORADO <br />arts <br />$2.344.00 application fee <br />$2.906.00 gassy application <br />51.933.00 amendment fee <br />52.344.00 conversion fee <br />O permitted a~,.es <br />0 acres <br />2. / lbs/Tons/vr <br />5. / lbslTons/vr <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: <br />