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~-1 ~ <br />- ,STATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />Department of Natural Resources <br />t3t35herman St., ROOm zis (~~R°r-;ppim ~r~ COLORADO <br />Denver, Colorado 80203 DIVISION o F <br />(/ MINERALS <br />Phone: (303) 866-3567 CONSTRUCTION MATERIALS r~T r~ <br />FAX: (303) 832-8106 Qlil L 'J ZC04 G E O L O G Y <br />LIMITED IMPACT (110) OPERATION <br />REC Lq NgTION•MIN ING <br />^'eisionofMiner!sffi6eology SAFETY•SCIENCE <br />RECLAMATION PERMIT APPLICATION FORM <br />Bill Owens <br />Govemar <br />Greg E. Walther <br />CI~CK ONE: X There is a File Numper Already Assigned to this Operation Executive DirecYOr <br />Permit # X1978=080 ,/ (please reference the file ntunber cturently assigned to this operation) Ronald W. Cattany <br />Division Director <br />New Application (Rule 1.4.5) x Amendment Application (Rule L 10) Natural Resource Tmstee <br />Conversion Application (Rule 1. i 1) <br />Pemtit # M -1978-080 __ (provide for Amendments and Conversions of existing permits) <br />The application for a Construction Materials Limited Impact (110) Operation Reclamation Permit cotttairts three major pans: (1) the application <br />form: (2) Exhibits A-J, Exhibit L, Addendum 1, any sections of Exhibit 6.5 and Geotcehnical Stability Exhibit, as required by the Office, and <br />outlined in Rules 6.1, 6.2, 6.3, 6.5, and 1.6.2(1)(b); and (3) the application fee. When you submit your application, be sure to include one <br />(1) complete simed and notarized IV ORY ORIGINAL and one (I) copy of the completed Ivon~ application form, two (2) copies of Exhibits <br />A-J, Exhibit L, Addendum 1, and appropriate sections of 65 (Geotechnical Stability Exhibit), as required, and a check for the application fee <br />described under (4) below. Exhibits should IQ be bound or in a 3-ring binder; maps should be folded to 8 I /2" X 11" or 8 ] /2" X 14" size. <br />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 apace provided, ALL information described below. <br />1. Aoplicantlocerator or comoanvname (name to be used on ce rmifl: Lincoln C o u n t v <br /> L1 T}'peoforganization (corporation, partnership, etc.): Government <br /> 1.2 1.2 LR.S.TaxIDNo.orSocialSectiriTyNumber: <br />2. OD erationoame(oit.mineorakename): Elmer Stone Gravel Pit <br />3. Permitted acreage (new or etdatin¢ site): 4 - 3 permitted acre, <br />3.1 Change in acreage (+) 5 •6 acres <br />3? Total Acreage in Permit Area 9 .9 acres <br />4. Fees: <br />4.1 New Application: $1.094.00 application fee <br /> AmendmentFce(C.R.S.34-32.5-125(I])): $719.00 application fee <br />4.2 Conversion Fee (from I l Od to 1 ]0 $875.00 conversion fee (Ru le 1.11.2(2)) <br />5. Primarvcommoditie(s)tobemined: Sand av 1 <br />5.1 Incidental commoditie(s) to be mined: 1. NA / ]bs/Tons/t~ 2. / lbs/fons/yr 3. / lbs/I'ons/vr <br />4. / Ibs/Ions/vr ~. / lbs/Tons/vr <br />5.2 Anticipated end useofprimarycommoditie(s)tobemined: County road maintenance 30 years <br />Anticipated end use of incidental commoditie(s) io be mined: NA <br />Office of Office of Colorado <br />Mined Land Reclamation Active and Inactive Mines Geological Survey <br />