1995-08-16_REVISION - M1980120 - Laserfiche WebLink

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• RrnC~~~C(~ ~ RHCLAMATIONT PHRMIT 2 ) AUG 16 1y95 APPLICATION FORM CHHCK ONfi: New Application (Rule 1.4.5) R Amendmc$~iiW6~~Rl,~fi~WAd(Rldb~ic~/•10) Conversion Application (Rule 1.11) !' Y~/1 _ © Q 1 Permit No. M- 80 _ 120 (provide for amendmeats(~ 'and)Lconvereiaasl of existing permits) The application for a Regular Operation Reclamation Permit contains three major parts: (1) the application form; (2) Rxhibits A-S and Geotechnical Stability Hxhibit; and, (3) the application fee. When you submit your application, be sure to include one (1) signed and notarized original and four (4) copies of the application form, five (5) copies of fixhibits A-R and nay required sections of Hxhibit S and the Geotechnical Stability Hxhibit, and a check for the application fee described under Section (16) on Page 3. Hxhibits should not be bound or in a 3-ring binder; maps should be folded to 8 1/2" X 11" or 8 1/2" X 14" size. To expedite processing, please provide the information in the format and order described in this form. ,-, eovecooeecocc.o==cco.eee.a.eeviceecoac=cvv= _.vc.e.avvv.vvvvc-nFx-_~z_____F___________c __ _____ __________ GHNHRAL OPHRATION INFORMATION M - S B'I o7O Type or print clearly, in the space provided, all information described below. - -------- ------------- ------ 1. Applicant/operator or company name (name to be used on permit): 1.1 Type of organization (corporation, partnership, etc.): Government 1.2 I.R.S. Tax ID No. or Social Security Number: 2. Operation. name (pit, mine or site name): Koenig Gravel Pit 3. Permitted acreage (new or existing site) 61.39 permitted acres 3.1 Change in acreage (+ or -) 0 ~ acres 3.2 Total acreage in Permit area 61.39 acres 4. Fees: 4.1 New Application 51.875.00 application fee 4.2 New Quarry Application 52.325.00 quarry application 4.3 Milling Application (Non-DMD) 53.100.00 milling application 4.4 Amendment Fee 51.550.00 amendment fee 4.5 Conversion to 112 operation (set by statute) S1.SOD.00 conversion fee 5. Primary commoditie(s) to be mined: sand gravel 6. Name of owner of surface of affected land: Weld Countv 7. Name of owner of subsurface rights of affected land: We d Countv If 2 or more owners, refer to Hxhibit O. 8. Type of mining operation: X Surface IInderground In-situ 9. Location information: the center of the area where the majority of.miniag sill occur lies in: 000'NTY: Weld PRINCIPAL MHRSDIAN (check one): ~. 6th (Colorado) 10th (New Mexicro) _ Dte SHCTION (write number): S 1~ TOWASHIP (write number and check direction): T ~_ X Aorth South RANGE (write number and check direction 7~ West QQARTHR SECTION (check one): _ NH _ NW SS _ SW QIJARTHR/QOARTHR SHCPION (check one): NS NW ~ Sfi SW GHNfiRAL DHSCRIPTION (miles and direction from nearest town and a pXoximate elevation): Four miles north and west of Fort Lupton, Colorado, loca~ed at the intersection on WCR 20 and WCR 25. ORIGINAL