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,~F COLORADO <br />DIVISION OF MINERALS AND GFO~g({1(r~~le ®~® <br />Department of Natural Resources r(t !9 <br />1313 Sherman SI., Room 215 <br />Denver, Colorado N0203 ~C I q ~ nrrfl9 <br />PFwne: (3031 a66-3561 L LYW <br />FA%: (30.3)n32-8706 <br />Division of Minerals and Geology <br />CONSTRUCTION MATERIALS <br /> <br />DIVISION Of <br />/NOV~6?0~ MINE[Z.ALS <br />GEOLOGY <br />Division of Minerals and Geals ) R E C L A M A T I O N <br />MINING•$AFETY <br />REGULAR (T 12) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM '~ cal Owens <br />Governor <br />Grel; E. Walther <br />EzecNive Directs <br />CHECK ONE: _ New Application (Rule 1.45) _ Amendment Applicadon (Rule LI O~rchael a. Eorlg <br />rvision Director <br />_~ Convenloo Application (Kula 1.11) <br />Permit # ~_- 1987 - 024-_ (provide for Amendments end Conversions of existing permits) <br />The application for a Ca-strlrcrian Materials Regular t 12 Operation Reclamation Permit contains throe major parts: (])the application form; <br />(2) Exhibits A-S, Addendmn 1, any sections ofExhibit 6S (Geotecbnical Stability Exhibit; and (3) the application fee. When you submit your <br />application, be sure to include one (1) ~plete s'~ted and notarized IVORY ORIGINAL and four (4) copies of the completed j,_gry <br />application form, five (5) copies of Exhibits A-S, Addendum 1, appropriate sections of 6.5 (Geotechmical Stability Exhibit, amd a check for <br />the application fee described under Section (4) below. Exhibits should ~O~ be bound or in a 3-rilrg binder; maps should be folded to <br />8 112" X 71" or 8 112" X 14" size. To expedite processing, please provide the information in the format aml order described in this form. <br />GENERAL OPERATION INFORMATION <br />Type or print chatty, im the space provided, ~ Information requested below. <br />1. ~,RoDatrUocerator or cemnanv name (naEylg,to be used on oermkl: Western Gravel. Inc. / <br />1.1 Type of organvation (corporation, partnership, etc.): Corpora i n <br />1.2 I:RS. Tax ID. No. or Social Security Number. <br />2. Operetion name (nit. mine o-r eke Hamel: Corey Gravel Pit #3 / <br />3. Permitted acreaee (new Gr existins skel: <br />3.1 Change in acreage (+) <br />3.2 Total acreage im Permit area <br />4. ~: _ <br />4.1 New Application <br />4.2 New Quarry Applirs[ion <br />4.3 Milling Application (Non-DMO) <br />4.4 Amendment Fee <br />4.5 Conversion to 1 l2 operation (set by statute) <br />5. Prime commoditie(sl to be mined: Sand Gravel <br />5.1 Incidental commoditie(s) to be mined: 1. Ibslfotts/vr <br />3. ! Ibslrons/vr 4. / Ibs/h'ons/vr <br />9.9 permitted acres <br />40.83 acres <br />50.73 acres <br /> <br /> application foe <br /> quarry application <br /> milling application <br /> amendment fee <br />234 conversion fee <br />2. l J¢ <br />5.2 Amicipated end use of primary commoditie(s) tn be mined: Construcuction agprepate. concrete agc3regate - <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: <br />