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-i'' <br />DIVISION OF MINERALS AND GEOLOGY <br />Department of Natural Resources <br />STATE OF COLORADO <br />7313 Sherman St., Room 215 RECEIVED <br />Denver, Colorado 80203 <br />Phone: (303) 8663567 <br />FAX: (303) 832.8106 CONSTRUCTION MATERIALS MAY 1 1 2004 ~ <br />~./ <br />~~ LIMITED IMPACT (110) OPERATION <br />Division at Minerals & Geology <br /> RECLAMATION PERMIT APPLICATION FORM <br />fOR SCANN/NG <br />(:HECK ONE: ~_ There is a File Number Already Assigned to this Operation <br />Petmi[ # M ~19 - 8 8 -0 22 2 (Please reference the file number currently assigned [o this operation) <br />New Application (Rlile 1.4.5) X Amendment Application (Rule 1.10) <br />Conversan Application (Rule 1.1 I ) <br />Permit # M - 19 8 8 0 2 a_ (provide for Amendmeeta and Conversions of existing permits) <br />OLORADO <br />I V I a l O N O F <br />INSRALS <br />EOLOGY <br />CLANATION•M INING <br />SAf ETY•SCIENCE <br />Bill Owens <br />Govemar <br />Greg E. Walther <br />Executive DIreCTOr <br />Ronald W. Cattany <br />Division Director <br />Natural Resource Trustee <br />The application for a Construction Materials Limited impact (110) Operation Reclamation Petmit ctantains three major parts: (1) the application <br />form; (2) Exhibits A-J, Exhibit L, Addendum 1, any sections of Exhibit 6.5 and t Teotechnical Stability Exhibit, as required by the Office, and <br />outlined in Rules 6.1, 6.2, 6.3, 6.5, and 1.6.2(1)(b); and (3) the application fee. When you submit your application, be sure to include one <br />(1) wmolete signed and notarized IVORY ORIGINAL and one (I) copy of the completed Ivory application form, two (2) copies of Exhibits <br />A-J, F,xhibit L, Addendum I, and appropriate sections of 6.5 (l:reotechnical Stability Exhibit), as required, and a check for the application fee <br />described under (4) below. Exhibits should NQT, be bound or in a 3-ring binder; maps sholild be folded to 8 1 /2" X 11" or 8 1 /2" X 14" size. <br />7'o 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 described below. <br />I . AnolicanUocerator or tromoanv uame (name to be used oo certnitl: `~ L i n C O 1 n Count y <br /> L1 Type of organization(wrporatfon,partnership,e[c.): Government <br /> 1.2 1.2 I.R.S. Tax ID No. or Social Security Number: <br />:;. Op erationname(oit.mineors@e name): Smith Ranch Pit #2 <br />:i. Permitted acreaee /new or ercistht¢ site): 4 permitted acres <br />3.1 Change in acreage (+) 5 . 8 acres <br />32 Total Acreage in Petntit Area 9 • 8 acres <br />'l. Fees: <br />4.1 New Application: $ ] 094.00 application fee <br /> Amendment Fee (C.R.S. 34-32.5-12~(II)): $719.00 application fee <br />4.2 Conversion Fee (from 110d to 110 $875.00 conversion fee (Rule 1.11.2(2)) <br />S. Primaryrnmmoditie(s)tobemined: Sand Gravest <br />5.1 Incidental commoditie(s) to be mined: 1. NA / ]bs/TonshT 2. / lbs/Tons/vr 3. ! Ibs(I'ons/vr <br />4. / Ibs/I'onshr ~. / lbs/Tonshr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: Road Ma i n t e n a n c e <br />Anticipated end use of incidental commoditie(s) to be mined: <br />NA <br />Office of Office of Colorado <br />Mined Land Reclamation Active and Inactive Mines Geological Survey <br />