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TATE OF COLORADO <br />pIVISION OF MINERALS AND GEOLOGY <br />Department of Natural Resources <br />1313 Sherman St., Room 215 <br />Denver, Colorado 80203 <br />Phone: (3031866-3567 <br />FAX: (3031832-8106 <br />CONSTRUCTION MATERIALS <br />REGULAR OPERATION (112) <br />ATION PERMIT APPLICATION FORM <br />Roy Romer <br />Governor <br />)amen S. Lo<hhead <br />Executive Director <br />Michael B. fool; <br />Division Oirector <br />C$ECR ONE: Hew Application (Rule 1.4.5) Amendment Application (Rule 1.10) <br />X Conversion Application (Rule 1.11) <br />M 92 51 and See Gover letter) <br />Permit # ~_-~.- 836 -_ 4provide for Amendments <br />existing permits) <br />and Conversions o: ~ <br />The application for a Regular 112 Operation Reclamation Permit contains three major parts: (1' <br />the application form; (2) Exhibits A-S, Addendum 1, any sections of Exhibit 6.5 (Geotechnica: <br />Stability Exhibit; and {3) the application fee. When you submit your application, be sure tt <br />include one (1) complete sicned and notarized IVORY oRIGiNAL and four (4) copies of the completer <br />ivory application form, five (5) copies of Exhibits A-S, Addendum 1, appropriate sections of 6.! <br />(Geotechnical Stability Exhibit, and a check for the application fee described under Section (4 <br />(below. Exhibits should not be bound or in a 3-ring binder; maps should be folded to 8'1/2" X 11' <br />of 8 1/2" X 14" size. To expedite processing, please provide the information in the format an. <br />order described in this form. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly in the space provided the information requested below. <br />1. Applicant/operator or companv~name (name to be used on permit): <br /> Flor ence Sand & Gravel <br /> 1.1 Type of organization (corporation, partnership, etc.): Sole PrOpr].etOr <br /> 1.2 I.R.S. Tax I.D. No. or Social Security Number: <br />2, Operation name (pit, mine or site name): Florence Sand & Gravel Pit <br />3. Permitted acreage (new or existing site) 17.18 permitted acres <br /> 3.1 Change in acreage (+ or -) Plus 60.26 acres <br /> 3.2 Total acreage in Permit area 77.44 acres <br />4. Fees• <br /> 4.1 New Application 51,85.00 application fe <br /> 4.2 New Quarry Application 52,325.00 quarry applicatio <br /> 4.3 Milling Application (Non-DMO) 53.100.00 milling applicatio <br /> 4.4 Amendment Fee ~ 550.00 amendment fe <br /> 4.5 Conversion to 112 operation (set by statute) 1 500.00 conversion fe <br />5. Primary commoditiefsl to be mined: Sand gravel <br /> S.1 Incidental commoditie(s) to be mined: 1. ,pj/A - ~ lbs/Tons/vr <br /> 2. / lbs/Tons/vr 3. / lbs/Tons/vr <br /> 4. / lbs/Tons/vr 5. / lbs/Tons/vr <br /> 5.2 Anticipated end use of primary commoditie(s) to be mined: Construction Aggreqat~ <br /> 5.3 Anticipated end use of incidental commoditie(s) to be mined: N/A _ <br />