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TATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY R~ECEI VED <br />D <br />f N <br />t <br />l R <br />epartment o <br />a <br />ura <br />esources <br />1313 Sherman St., Room 215 <br /> <br />Denver, Colorado 80203 p <br />SEf ~ 0 203 <br />Phone: (303)866-3567 <br />FAX: 1303)832-8106 <br /> Division of Minerals and Geology <br /> CONSTRUCTION MATEHIALS <br /> REGULAR (112) OPERATION <br /> RECLAMATION PERMIT APPLICATION FORM <br />CHECK ONE: _~ There is a FDe Number Already Assigned to thin Operation <br />Permit # M •~~" _-,ter -_ (Please reference the ftle number cmTently assigned to this aperatioa) <br />_ New Application (Role 1.4.5) _ Amendment Application (Rule 1.10) <br />Conversion Application (Rule 1.11) <br />Permit # ~-Zcc I - cEG -_ (provide for Amendmeota and Conveniom of extstmg permits) <br />t1L\~ <br />D I~'151 ON O F ~ <br />MINERALSI <br />GEOLOGY <br />RECLAMATION <br />MINING•SA FE TY <br />Bill Owens <br />GOVemor <br />Greg E. Walther <br />Executive Director <br />Ronald W. Cottony <br />Acting Division Director <br />The application for a Construction Materials Regular 112 Operation R,xlamatiou Permit contains three major parts: (I) the apphcation form; <br />(2) Exhibits A-S, Addends 1, any sx~ons of Exhibit 65 (Geotechnical Stability Exhibit and (3) ffie application fee. When yon submit yoitr <br />applicaliaiq be sme to iminde ®e (I) cumulate sued and notarized IVORY ORIGINAL and 1)ffi (I) copy Of the completed Ivor application <br />form, two (2) copies ofExhlbiec A-S, Addendum 1, appropriate sections of 63 (Geotechttical Stability Exhibit, and a check far the application <br />fee desrarbed under Section (4) below. Exhibits should NOT be bottnd ce in a 3-ring binder; traps should be folded to 8 12" X 11" or 81/2" <br />X 14" size. To expedite pml:essing, please provide the information is the 1:o~at and cruder des<atbedm ibis fc®. <br />CrEAIERAI_ OPERATIDN INFORMATION <br />Type or print ckarly, in the apace provided, ALL information regneated below. <br />1. Aoolicant/ooerator or comosnvname (name to be Hoed on cevmitl: 8 ~ C tvTcYL P ~ScS f t_l_ L <br />1.1 Type of orgatdration (corporation, partnership, etc.): 1°- L ~- <br />1.2 LRS. Tax ID. No. m Social Security Num-beer: 4't - o $$ (1 $(~ <br />2. Ooeratioo name loft. mine or Bite oamel: `J ~~~=^1S ~T ~~., <br />3. Permitted acreaee (new or evstms site): ~-9 •~pe~..uitted acres <br />3.1 Change in acreage (+) 13 . lc: acres <br />3.2 Total acreage m Permit area 2 3 . S ~ acres <br />4. Fees: <br />4.1 New Application 52 344.W application fee <br />4.2 New Qoe[ty Application 52.906.00 quarry application <br />4.4 Amendment Fee 57.938.00 amendmc~t fee <br />45 Conversion to 112 operation (set by statute) 52.344.00 conversion fee <br />S. Primary commoditie(sl to be mined: G K l1:ycL s_ (Y n iy~ <br />J.1 111e1deIItal COIDIIIOdIIIe{S) t0 Ile Ironed: I. Y =~-~-G1' K ~ i CC"' 1bSlIOIIS/Yi 2. / ]t)S(TOES(V7 <br /> 3. / Rls/I'ons/vr 4. / Ibs/Tons/vr 5. ! 1bsrTons/vr <br />5? Anticipated end use of primary commoditie(s) to be mined: Crr-/ S i~Z.; e i ~ .' `' /7~~ i~I~ 1 ,-t ~ <br />5.3 Anticipated end Ilse of iucidrntal cotnmatiitie(s) to be mined: C~~ ^f ~ i"r? ~ ~ tT` •~. %1 ~~I i rr.%.i .I ~ <br />