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TATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY ~7 r e <br />Department of Natural Resources RECD v E® <br />1313 Sherman St., Room 215 - ~ D I v t s I o N o r <br />Denver, Colorado 80203 It pp 1 7 ~fOM1 <br />Phone: (303) 866-3567 Fif R I f L UL 1~'1 I l~I E RA L $ <br />FAX: (303)832-8106 & <br />fliuision of Minerals and Geology G E O L O G Y <br />CONSTRUCTION MATERIALS a E c t A M A n o N <br />MI NING•SA FETY <br />REGULAR (112) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM Bill Owens <br />Governor <br />Greg E. Walther <br />Executive Director <br />CHECK ONE: `New Application (Rule 1.4.5) _ Amendment Application (Rule 1.1 ichael B. Long <br />Division Director <br />XX Conversion Applicator (Rule 1.11) <br />Permit # M -1~- 3R ~ -_ (provide for Amendments and Conversions of existing permits) <br />The applicator for a Cons[rucfion Materials Regular 112 Operafion Reclamation Permit contains three major pazts: (1) the application form; <br />(2) Exhibits A-S, Addendum 1, any sections of Exhibit 6.5 (Geotechnical StabilityExhibit; and (3) the application fee. When you submit your <br />application, be sure to include one (1) complete sieved and notazized IVORY ORIGINAL and four (4) copies of the completed Ivorv <br />application farm, five (5) copies of Exhibits A-S, Addendum 1, appropriate sections of 6.5 (Geotechnical Stability Exhibit, and a checkfor the . <br />applicafion fee described under Secfion (4) below. Exhibits should NOT be bound or in a 3-ring binder; maps should be folded [0 8 1/2" X 11" <br />or 8 1/2" X 14" size. To expedite processing, please provide the informafion in the format and order described in this form. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, m the space provided, ALL information requested below. . <br />1. Aoalicant/oaerator or comoany name (name to be used on oermi~: Walsenburg Sand & Gravel, Inc. <br />1.1 Type of organization (corporation, partnership, etc.): <br />1,2 I.R.S. Tax I.D. No. or Social Security Number: - <br />2. Operation name (pit, mine or site name): Sanri ar,-non v; r <br />3. Permitted acreage (new or existing site): 9 permitted acres <br />3.1 Change in acreage(+) <br />3.2 Total acreage in Permit azea <br />4. Fees: <br />4.1 New Application <br />4.2 New Quarry Application <br />4.4 Amendment Fee <br />4.5 Conversion to 112 operation (set by statute) <br />5. Primary commoditie(s) to be mined: ca.,A _F o Rnr•k <br />5.1 Incidental commodite(s) to be mined: 1. - Ibs/I'ons/vr <br />3. / lbsi'I'ons/vr 4. / lbs/pons/vr <br />5.2 Anficipated end use of primary commodite(s) to be mined: <br />None <br />43 acres <br />acres <br />$2.344.00 application fee <br />$2.906.00 quarry application <br />1 0 amendment fee <br />44 conversion fee <br />2. / lbs/I'ons/vr <br />5. / lbs/Tons/vr <br />5.3 Anficipated end use of incidental commoditie(s) to be mined: <br />