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N~~~ ~ <br />• <br />5 rA-rE <br />DIVISION OF MINERALS AND GEOLOGY <br />Department of Natural Resources <br />COLORADO <br /> <br />1313 Sherman St., Room 215 JAN 0 6 2003 / <br />Denver, Colorado 80203 DIVISION O F <br />FAXn(~(3y03®)38~6g6,3~5g6t7 ~y~,p REGUT.AR( 12NOP~RAT O~atsran of Minerals artd ~g0 '~'I I N &RA L 5 <br />rILC l.~t' R t~ ~r ~ F n t n r_ v <br />F®1/ V (//y/!//YI~MATION PERMTT APPLICATION FORM _R E C L A M A T I O N <br />/ MINING•SAFETY <br />Bill Owens <br />Governor <br />CHECK ONE: There is a File Number Already Assigned to this Operation <br />Greg E. Walther <br />Permit # M -_ _ - (Please reference the file number currently assigned to this operation) Executive Director <br />Michael B. Long <br />_ New Application (Rule 1.4.5) /xx Amendment Application (Rule 1.10) Division Director <br />_ Conversion Application ~e 1.11) <br />Permit # M - 9 2 - O 1 6 __ (provide for Amendments and Conversions of existing permits) <br />The application for a Conshvction Materials Regulaz 112 Cperation Reclamation Permit contains three major pate: (1) the application form; <br />(2) Exhibits A-S, Addendum I, any sections of Exhibit 6.5 (Geoteclmical Stability Exhibit; and (3) the application fee. When you submit your <br />application, be sure to include one (1) comulete signed and notarized IVORY ORIGINAL and four (4) copies of the completed Ivy <br />application form, five (5) copies of Exhibits A-S, Addendum 1, appropriate sections of 6.5 (Geotecltnical 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 INFO1tMATION <br />Type or print clearly, in the apace provided, aU information described below. <br />1. Aoo6canUooerator or comoanv name (name to be need on oermit): <br />1.1 Type oforgattization(corporation,partnership,etc.): Corporation <br />1.2 I.R.S. Tax I.D. No. or Social Security Number: <br />2. Operation name (ok, mine or ske namel: Penrose Ranch' s <br /> <br />3. Permitted acrea¢e (new or eaittin+s site): 2 2 4 permitted acres <br /> 3.1 Change in acreage (+) 2 2 6 0 acres <br /> 3.2 Total acreage in Permit area ~ d R 4 acres <br />4. Fees: <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 Fee $1,938.00 amendment fee <br /> 4.5 Conversion to 112 operation (set by statute) $2 344.00 conversion fee <br />5. Primary commoditie(s) to be mined: Sand gravel <br /> 5. ] Incidental commoditie(s) to be mined: I. / lbslTonsPor 2. / Ibs/Tons/vr 3. / lbs/Tons/vr <br />. <br /> 4. / lbs/foas/vr 5. / lbs/Tons/vr <br />5.2 Anticipated end use of primary commoditie(s)tn be mined: Asphalt concrete con rt inn, larl <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: s c ape <br />