Laserfiche WebLink
STATE OF ~~ dOR~DO <br />DiYl510N OF MINERALS AND GEOLOGY 00~ rLO~I <br />Department of Natual Rewurces ~ <br /> <br />215 <br />h ,.n FI' G~ 2~ ~~ p ~ L ~ IAA D O <br />Colo ado 80203 <br />Denver CONSTRUCTION MATERIALS Out~'_,' .r ~^ d5~ ~ M I N E RA L S <br />Phone: (30318663567 <br />FAX: (3031832.8108 <br />REGULAR (112) OPERATION •~~~~•~ 3n <br />ON I,piP~J <br />G E O L O G Y <br /> RECLAMATION PERMIT APPLICATION FORM REC LANATION•NINING <br /> SA FETY•SCIENCE <br />&Il thveaS <br />CHECK ONE: ~ There is a Fik Number Already Assigned to this Operation cwemor <br />Greg E. Walther <br />Petmit # M -,~~-~ (Please reference the file ntunber cturently assigned to this operation) Executive Director <br />_ New Application (Rule 1.4.5) _ Amendment Application (Rule 1.10) aoraid w. Cattany <br />Conversion Application (Rule 1.11) Division Director <br />Natual aewurce Trustee <br />Pem»t # M -~~- 16 4 -_ (provide for Amendments and Conversions of existing pemrits) <br />The application for a Construction Materials Regular 112 Operatod Reclamation Permit contains three major parts: (1) the application form; <br />(2) Exhibits A-S, Addendum 1, arty sections of Exhibit 6S (Geoteclrtncai Stability Exhibit; and (3) the application fee. When you submityour <br />application, be sure to include one (1) complete signed and notarized IVORY ORIGINAL and one (1) copy ofthe completed I~ application <br />form, two (2) copies ofExhibits A-S, Addendum 1, appropriate sections of 6.5 (Geotechnical Stability Exhibit, and a check for the application <br />fee described under Section (4) below. Exhibits should NOT be bound or in a 3-ring binder, maps should be folded to 812" X 11 ^ or 812" X <br />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 space provided, ALL information requested below. <br />1. AoolicanUooerator or oomoaov name (name to be used on oerm~i+t): ~-~Ic...OK'C12, ~ l~X'A~l'P U y~ <br />1.1 Type of organvation (corporation, partnership, etcJ. S2~-C ~Y'D(~t' Irc`~OY~ <br />1.2 I.R.S. Talc I.D. No. or Social Security Number: <br />2. Operation name tnit, mine or site name): <br />3. Permitted acreage (new or et;isNng site): <br />3.1 Change in acreage (+) <br />3.2 Total acreage in Permit area <br />9.~b <br />+ 55.5x8 <br />(05, lg8 <br />4. Fcea <br />permitted acres <br />acres <br />acres <br />4.1 New Application $2.344.1)0 application fee <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) $2344.00 conversion fee <br />5. Prim arvrnmmoditiefsltobemined: _a <br />~.uel <br />5.1 / <br />Incidental commoditie(s) to be mined: 1. N~ - ibs/Tons/~r 2. / Ibsfl'ons/vr <br /> 3. / !bs(fons/vr 4. / lbs/Tons/vr 5. / Ibs/Tonsivr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: ~ ~ nV•PtI'i ~ [~S-Q, <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: ~~,D <br /> Office of Office of Coloado <br />EAL.e.1 ; ...d o„-;-,,,-~;,,~ Artiva and Inarfivn Mincc re..1....:~el c..n.e.. <br />