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STATE OF COLORADO <br />DIVISION OF MINERALS AND GEOWGY <br />UataanKau oI Nmural Resoacrs <br />1313 Slroonarl St, Roan 215 C O LO RAD O <br />DprIYM, foloado 80203 D l Y 1 S 1 0 N O F <br />MIN RA L S <br />Ptlono: t3W) e8G3587 CONSTRUCTION MATERL113 <br />FAX: (3031832$108 REGIILAR p 12) OPERATION G E O L O G Y <br />RECLAMATION PERMIT APPLICATION FORM et urin~cri"iciNO <br />Bill Owfn> <br />Ga~emor <br />CHECK ONF.: X There b a Fik Nntaber Already Anq(ned b thb Opearion aDHea eaD~ae <br />Permit # M -1~ -~-ezB (Please referalce the Slo ntanber cutrattly assigned [o this operation) ~A° ~ie°O' <br />_ New Application (Ruk 1.4.5) _ Ameadmtat Application (Rule I.1 D) avalan p;,~ <br />~ Convereion Application (Rule 1.11) N"uN.l ~Oi1° T""'~ <br />Permit # _(tv _. 19 -~_' C2 (ptrntide for AtaoadneeMa sad Catrarrbos of eltisiing permiu) <br />The eppticetion for a Construction Materials Regular 112 Operation Rerlametion Permit contains t}rree major paris: (1) tt~ application form; <br />(2) Exhibits A-S, Addendum 1, arty sections of Exhibit 6.5 (Geoteclmicel Stability Exhibit; end (3) the application fee. Whenyou submityour <br />npplicetiw, 6e sure to include aIe (I) complete stoned and rvotarized ORIGIIV,~L and one (1) copy oftht completed application form, ttvo(2) <br />copiesofExhibits A-S, Adde~m I, appropriate sections of6.5 (Geotecimicel Stability Exhibit, and a check for the application Cee described <br />order Section (4) below. Exhibits should ~ be bawd w is s 3-ring bbder; maps should 6e folded to 8 12" X 1 1"~ 8 12" X 14" size To <br />axpudite pruces~eittg, please provide the information in the format and order describedm This Corm. <br />GENERAL OPERATION INFORMATION <br />Type or print cktrrly" in the span provided, ELI iotormatibD regiceated bebw- <br />1. ADnlieant/ooentor ormmoanv DaOMr (nanx to be used en rrerooitl: ~+I~ty.Do MAP$1~. -~KG. <br />1. I Type of organization (corpa'etion, parutership, etc J: ~4R-PoP..°.T 1 c? N <br />2. ODeration name (gjij. mine or a#e naoteY. ~ ti-~`Y M t N t=g ' <br />3. Permkted acxa¢e /neFr or eahiina site): ~~~ ~'e "t ~ ~ 1 O permitted acres <br />3. i Change W acreage (+) G'l- acres <br />3.2 TutalacreageinPemtitarra OCT 1 1 2005 ~2 acres <br />4' ~ CHAFFEE G.. - ! <br />4.l New Apphcauat CLEflK AIdD RECORDER 82344,tID application fce <br />4.2 New Quarry Appli~ttion~/~//// ,~'yt 82.9tY,,0D quarry application <br />4.4 Amendment Fee U~' ~ O D r " 51.938.1k1 amrndmeot fee <br />/4.5 Conversion to 11 Z operation (set by statute) JQ ~ $2344.0(1 wnveraion fee <br />i. Prhearv eommoditt~l to be mhted: ~)Ay-yt~ <br />5.1 Incidental commoditie(s) to be mined: 1. PI~ _ IbsffntLShr 2. / Ibs/I'onshT <br />3. ! IbsR'onshrt 4. ! "-^'---`- < ~ ~~~'....-A+ <br />5.2 Anticipated end tt~ of ptirnary commodities} to be min <br />5.3 Anticipated end use of incidental comtntxlitie(s) to be m~ ^ ~ ~ v !~ ,r ~~+-~ <br />NO. J~atE /E~ ~ ~~- L 1 <br />e~ECelv~c~ of -~~~ <br />cr <br />~~n <br />~ ~~1 pyy pq qg <br />tvt11~ W w Iteclamarlon q qy Na art FOR SEPVICES/PgODIICTS RENDERED /~ `~'/' ~ '~/~ 4r Zu~/~ ~ ~aa nr <br />F~ID® W IL't~` THANK VOUI CHAFFEE COUNTY CLERK AND RECORD <br />AMOU"r ACCOUNr~ E-~ PO. BOx 699-Salitla, C081201 <br />. OC I I y qoo~ ~ Telephone: 5394004 <br />Y L THIS PAYMENT <br />1' ^CHECK ^CASH $ ~/ ~y~~,/ <br />CHr1FFEE COUNTY BALANCE ! : eY 7 ~"-I--~~~+.-<aCJ:~ <br />CLERK AND RECORDER <br />