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-4- <br /> �. REGULAR OPERATION (112) <br /> RECLAMATION PERMIT <br /> APPLICATION FORM <br /> CHECK ONE: _ New Application (Rule 1.4 .5) X Amendment Application (Rpile 1.10) <br /> Conversion Application (Rule 1.11) <br /> Permit # M 94 _ 093 (provide for amendments and conve sipons of existing <br /> permits) NOV 10 �H <br /> The application for a Regular Operation Reclamation Permit contains three major parts: (1) <br /> the application form; (2) Exhibits A-S and Geotechnical S �y�i kj ) DUI , (3) the <br /> and <br /> application fee. When you submit your application, be sure o iac u e one 1 signed <br /> notarized original and four (4) copies of the application form, five (5) copies of Exhibits <br /> A-R and any required sections of Exhibit S and the Geotechnical Stability Exhibit, and a <br /> check for the application fee described under Section (16) on Page 3. Exhibits should not <br /> be bound or in a 3-ring binder; maps should be folded to 8 1/2" X 11" or 8 1/2" X 14" size. <br /> To expedite processing, please provide the information in the format and order described in <br /> this form. <br /> __� 2_a� l=________------ 1a8S= <br /> GENERAL OPERATION INFORMATION <br /> Type or print clearly, in the space provided, all information described below. <br /> 1 . Applicant/operator name: Cooley Gravel Comoany <br /> 1.1 Type of organization (corporation, partnership, etc.) : An 1 ad i a n a. Corporation , <br /> 1.2 I.R.S. Tax I.D. No. : 04 -040340 licensed to do business in Colo- <br /> Operation name (pit, mine or site name) : Dahlia North Resources Pit <br /> rado . <br /> 3 . Permitted acreage (new or existing site) 180 . 1 permitted acres <br /> 3 .1 Change in acreage (+ or -) + 1 0 .4 + acres <br /> 3 .2 Total acreage in Permit area 19-0 . acres <br /> 4 Fees: <br /> 4.1 New Application $1,875.00 application fee <br /> 4.2 New Quarry Application $2,325.00 quarry application <br /> 4 .3 Milling Application (Non-DMO) $3,100.00 milling application <br /> 4.4 Amendment Fee $1.550.00 amendment fee <br /> 4 .5 Conversion to 112 operation (set by statute) $1,500.00 conversion fee <br /> 5 . Primary commoditie(s) to be mined: sand grave-1 <br /> 6 . Name of owner of surface of affected land: Cooley Gravel Company <br /> 7 . Name of owner of subsurface rights of affected land: Cooley Gravel Company <br /> If 2 or more owners, refer to Exhibit 0. <br /> a . Type of mining operation: _2L Surface _ Underground <br /> 9 . Location Information: the center of the area where the majority of mining will occur <br /> lies in: Adams <br /> COUNTY: <br /> PRINCIPAL MERIDIAN (check one) 6th (Colorado) _ 10th (New Mexico) _ Ute <br /> SECTION (write number) : S <br /> TOWNSHIP (write number and check direction) : T '2 North X South <br /> RANGE (write number and check direction) : R _ — East 2L__ West <br /> QUARTER SECTION (check one) : NE _NW X SE _ SW <br /> QUARTER/QUARTER SECTION (check one) : X NE Nw SE SW <br /> GENERAL DESCRIPTION (miles and direction from nearest town and approximate elevation) : <br /> Prope•tty is , bein-g annexed into Commerce City . Only other town within <br /> 2 miles is the City of Thonnton . Approximate elevation - 5070 ' . <br /> ORIGINAL <br />