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~-o ~ ~ ~ <br /> STATE OF COLORA~=O <br />DIVISION OF MINERALS AND <br />Department o(Natural Resources GEOLOGY <br />1313 Sherman St., Room 215 <br />Denver, Colorado 60203 DIVISION o <br />Phone: (303) ab6-35b7 CONSTRUCTION MATERIALS M I N E RA L <br />FAX: (303) 932-8106 REGULAR (112) OPERATION / 6i <br /> G E O L O G <br /> RECLAMATION PERMTT APPLICATION FORM RE CLA MATIO <br /> MINING•SAf ET <br />Bill Owens <br />Governor <br />CHECK ONE: There is a File Nutgber Already Assigned to this Operation <br />Permit # M -g2-~-_~ (Please reference the file number currently assigned to this operation) <br />_ New Application (Rule 1.4.5) <br />_~ Amendment Application (Rule 1.10) <br />Conversion Application (Rule 1.11) <br />Permit # M •_ (provide for Amendments and Conversions of existing permits) <br />Greg E. Walther <br />Ezeculive Director <br />Michael B. Long <br />Division Director <br />The application for a Construction Materials Regular 112 Operation Reclamation Permit contains three major parts: (1) the application form; <br />(2) Ex}ubits A-S, Addeadtmi 1, a~ sections of Exhib¢ 6.5 (Geotechnical Stability Exhtbit; and (3) the application fee. When you submit your <br />application, be sure [o include one (1) complete signed and notarized IVORY ORIGINAL and four (4) copies of the completed Ivory <br />application form, five (5) copies of Exhtbits A-S, Addendum 1, appropriate sections of 6.5 (Geotechnical Stability Exhibit, and a check for <br />the application fee described under Section (4) below. Exhibits should NOT be bound or in a 3-ring binder, maps should be folded to <br />8 1/2" X 11" or 8 1/2" 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 apace provided, all information described below. <br />I. A~olicaoUooerator or comoanv name (name to be used on oermit): <br />nnckalc (•onatruction Inc dba Yampa Ag¢reeates <br />1.1 Type of organization (corporation, partnership, etc.): Corporation <br />1.2 LRS. Tax LD. No. or Social Security Number: <br />2. Operation name (pit• mine or site name <br />3. Permitted acrea¢e (new or eaiatine site): 51± permitted acres <br />3.1 Change in acreage (+) 0 acres <br />3.2 Total acreage in Petmit area 51 + acres <br />4. Fees: <br />4.1 New Application $2.344.00 application fec <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) $2.344.00 conversion fee <br />5. Primary commoditie(s) to be mined: Gravel <br />5.1 Incidental commoditie(s) to be mined: 1. / 1bs/Tons/vr 2. / 1bs/Tms/vr 3. ' / 1bslTons/vr . <br />4. / lbs/Tons/yr 5. / lbs/Tonshvr <br />5.2 Anticipatedeaduseofprimarycommoditie(s)tobemined: used in the Construction Industry <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: <br />