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STATE OF COLORADO <br /> DIVISION OF MINERALS AND GEOLOGY <br /> Drparimem of Natural Kex,urces <br /> I ;I S Sherman St., Roam 215 <br /> Denver,Colorado W203 D I V 1 5 1 0 N O F <br /> Phone:(30 0 1366 3567 MINERALS <br /> FAX i.103)832 8106 & <br /> GEOLOGY <br /> CONSTRUCTION MATERIALS MINING-SAFETY <br /> REGULAR(112)OPERATION <br /> RECLAMATION PERMIT APPLICATION FORM 6.11 <br /> Governor <br /> Greg E Watcher <br /> Executive Director <br /> CHECK ONE: New Application Rule 1.4.5 Amendment Application Rule L101N magi B.tong <br /> PP ( ) pp ( V rhrs n Director <br /> Conversion Application(Rule 1.11) <br /> Permit S M --e�/ - ys1-_ (provide for Amendments and Conversions of existing permits) <br /> The application for a Construction Materials Regular 112 Operation Reclamation Permit contains three major parts:(1)the application form; <br /> (2)Exhibits A-S,Addendum 1,any sections of Exhibit 6.5(Geotechnical Stability Exhibit;and(3)the application fee. When you submit your <br /> application, be sure to include one (1) complete signed and notarized IVORY ORIGINAL and four (4) copies of the completed Ivory <br /> application form,five(5)copies of Exhibits A-S,Addendum 1,appropriate sections of 6.5(Geotechnical Stability Exhibit,and a check for <br /> the application fee described under Section (4) below. Exhibits should NOT be bound or in a 3-ring binder; maps should be folded to <br /> 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. <br /> GENERAL,OPERATION INFORMATION <br /> Type or print clearly,in the space provided,ALL information requested below. <br /> 1. Aoolicant/ooerator or company name(name to be used on Permit): Rose 2^cYurst�L <br /> 1.1 Type of organization(corporation,partnership,etc.): /)AP nw)i ry l ' sf <br /> 1.2 I.R.S.Tax I.D.No.or Social Security Number: Spa f{- 3 L/ — J �t3 e) (� / <br /> 2. Operation name(pit,mine or site name): BUSY- PvrndU U5 QVOI)EI I f iT l <br /> 3. Permitted acreage(new or existing site): / '�, i permitted acres <br /> 3.1 Change in acreage(+) acres <br /> 3.2 Total acreage in Permit area acres <br /> 4. Fees: <br /> 4.1 New Application $1,875.00 application fee <br /> 4.2 New Quarry Application $2,325.00 quarry application <br /> 4.3 Milling Application(Non-DMO) $3,100.00 milling application <br /> 4.4 Amendment Fee $1,550.00 amendment fee <br /> 4.5 Conversion to 112 operation(set by statute) $1,875.00 conversion fee <br /> 5. Primary commoditie(s)to be mined: �¢ fn1t y0� pyy <br /> 5.1 Incidental commoditie(s) to be mined: I. - Ibs/Tons/vr 2. / Ibs/Tons/vr <br /> 3. / Ibs/Tons/vr 4. / Ibs/Fons/vr 5. / Ibs/Tons/vr <br /> 5.2 Anticipated end use of primary commoditie(s)to be mined: <br /> 5.3 Anticipated end use of incidental commoditie(s)to be mined: <br />