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,~,1 <br />CONSTRUCTION MATERIALS ` `'~~'~~ ~~~ <br />REGULAR (112) OPERATION ~E~ Q ~ j~~$ / <br />RECLAMATION PERMIT APPLICATION FORM <br />.._.,.., . f i......:r_la .... <br />CHECK ONE: There is a File Number Already Assigned to this Operation <br />Permit # M -~- 472= (Please reference [he file number currently assigned to [his operation) <br />New Application (Rule 1.4.5) -Amendment Application (Rule 1.10) <br />X Conversion Application (Rule 1.1 l)~ <br />Permit # M - 77 - 472 (provide far Amendments and Conversions of existing permits) <br />The application for a Construction Materials Regular 112 Operation Reclamation Permit contains three major parts: (1) the application form <br />(2) Exhibits A-S, Addendum 1, any sections of Exhibit 6.5 (Geotechnical Stability Exhibit; and (3) the application fee. When you submit you <br />application, be sure to include one (I) complete signed and notarized ORIGINAL and one (1) copy of the completed application form <br />two (2) copies of Exhibits A-S, Addendum 1, appropriate sections of 6,5 (Geotechnical Stability Exhibit, and a check for the application fei <br />described under Section (4) below. Exhibits should NOT be bound or in a 3-ring binder; maps should be folded [o <br />8 1 /2" X 11" or 8 1/2" X 14" size. To expedite processing, please provide the information in the format and ord er described in this form. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, ALL information requested below. <br />1. A~olicant/operator or comoanv name (name to be used on permit): JACKSON OOUNIY ROAD & BRIDGE <br />1.1 Type of organization (corporation, partnership, etc.): COUNTY-LOCAL GOVERNEMEN-CORPORATION <br />1.2 I.R.S. Tax I.D. No. or Social Security Number: <br />2. Operation name (pit, mine or site name): BLM EAST GRAVEL P[T <br />3. Permitted acrease (new or existine site): <br />3.1 Change in acreage (+) <br />3.2 Total acreage in Permit area <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: SAND GRAVEL <br />5.1 Incidental commoditie(s) to be mined: I. - Ibs/Tons/vr <br />3. / Ibs/Tons/vr 4. / Ibs/Tons/vr <br />permitted acres <br />acres <br />32.25 acres <br />$2.344.00 application fee <br />$2,906.00 quarry application <br />$1.938.00 amendment fee <br />$2.344.00 conversion fee <br />2. / Ibs/Tons/vr <br />5. / Ibs/Tons/vr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: COUNTY ROAD SURFACING <br />5.3 Anticipated end use of incidental commoditie(s) [o be mined: <br />