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~;p ~&s~o ~l, 938. co <br />STATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />Department of Natural Resources <br />1313 Sherman St., Room 27 5 <br />Denver, Coloratlo 60203 <br />Phone: (303) 866-3567 <br />FAX: (303) 632-8106 <br />CONSTRUCTION MATERIALS <br />REGULAR (112) OPERATION <br />RECLAMATION PERMTf APPLICATION FORM <br />DIVISION O F <br />-"~G IN~RALS <br />/~Ejo~)~ GEOLOGY <br />p/YisinnGf RECLAMATION <br />~// Mlnara/a anf/G~INING•SA FETY <br />Bill 'ens <br />Governor <br />/ - - ~ Greg E. Walther <br />v/ Executive Director <br />New Application (Rule 1.4.5)Amendment Application (Rule 1.1 ichael 9. Long <br />bivision Director <br />_ Conversion Application (Rule 1.11) <br />Permit # _ Ivy- 2co/ - o SS -_ (provide for Amendments and Conversions of etdsting peamits) <br />application for a Construction Ivlaterials Regular 112 Operation Reclamation Permit contains three major parts: (1) the application form; <br />?xhibits AS, Addendum 1, any sections of P~cltibit 6.5 (Geotechttical Stability Exhibit; and (3} the application fee. When you submit your <br />ication, be sure to include one (1) complete si¢ned and notarized IVORX ORIGINAL, and four (4) copies of the completed Ivory <br />ication form, five (5) copies of Exhibits A-S, Addendum 1, appropriate sections of 6.5 (Geotechnical Stability Exhibit, and a check for the . <br />icadon fee described under Section (4) below. Exhibits should NOT be bound or in a 3-ring binder; maps should be folded to 8 1/L" X 11" <br />1CL" X 14" size. To expedite processing, please provide the information in the format and order described in this form. <br />VL`lYL]{V1L V!"1i1V111V1\ 11Y1`V111V1A11V1`1 ~~ - ~ V <br />Type or print clearly, in the space provided, ALL information requested below. <br />"Annlicantlooetator or comaanv name (name to be used on oermifl: ~-2~~ .4S>~~S /a r~{suer^s, ~C <br />1.1 Type of organization (corporation, partnership, t <br />1.2 I.R.S. Tax I.D. No. or Social SectnityNumber: <br />~~ <br />Operation name (uit. mine or site namel: /°2 y ~S{w><e5 Sa.r.. d "^ d Gra vt ~ ~ "/iiy e <br />Permitted acreage (new or e~stmst sitel: -3~ 3 permitted acres <br />3.1 Changein acreage (+) <br />3.2 Total acreage in Permit area <br />Fees <br />/. 5/ acres <br />~ ~• 8/ acres <br />4.1 New Application $2.344.00 application fee <br />4.2 New Quarry Application $2.906.00 quarry application <br />4.4 Amendment Pee $1.938.00 amendment fee <br />4.5 Conversion to 112 operation (set by statute) $2.344.00 conveasion fee <br />Primary commoditie(s) to be mined: ~~! ~ <br />5.1 Incidental commoditie(s) to be mined: 1. 1Vi9 - lbs/Tons/yr 2. / lbs/1'ons/~ <br /> 3. / lbs/I'ons/}3 4. / lbs/I'ons/y~ 5. / lbs/I'ons/yr <br /> <br />5.2 <br />Anticipated end use of primary commoditie(s) to be mined <br />: ~-r/NJ~'a~r~~r~. 4c <br />{ y 1'a~Q-{r° / <br />r"~ac~ p4Se <br />5.3 Anticipated end zest of incidental commoditie(s) ro bemined: %1i <br />