Laserfiche WebLink
ILE COPY <br />fOR SCANNING <br />.~,~ - ~ <br />STATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />Department of Natural Resources <br />1313 Sherman St., Room 215 <br />Denver, Colorado 80203 <br />Phone: 1303) 866-3567 CONSTRUCTION MATERIALS <br />FAX: (3031 832-8106 <br />F~ ~ ~ ~ ~ V E ® LIMITED IMPACT (110) OPERATION r~ <br />OCT ~ B Myn RECLAMATION PERMIT APPLICATION FORM <br />Division of Minerals and Geology <br />CHECK ONE: ~ There is a File Number Already Assigned to tbis Operation <br />Permit # M -,9 -~~-~1$ (Please reference the file number currently assigned to this operation) <br />New Application (Rule 1.4.5) <br />Conversion Application (Rule 1.11) <br />_ Amendment Application (Rule 1.10) <br />'TFZ-o1 <br />Permit # M -~-~~-])Q, - (provide for Amendments and Conversions of existing permits) <br />~~ <br />DIVISION O F <br />MINERALS <br />GEOLOGY <br />RECLAMATION <br />MINING•SAFETY <br />Bill ovens <br />Governor <br />Greg E. Walther <br />Executive Director <br />Michael a. Long <br />Division Director <br />The application for a Construction Materials Limited Impact (110) Operation Reclamation Permit contains three major parts: (I) the <br />application form; (2) Exhibits A-J, Exhibit L, Addendmn 1, any sections of Exhibit 6.5 and Geotechnical Stability Exhibit, as required by the <br />Office, and outlined m Rules 6.1, 6.2, 6.3, 6.5, and 1.6.2(1)(b); and (3) the application fee. When yon submit your application, be sure to <br />include one (1) complete sued and notarized IVORY ORIGINAL aad one (1) copy of the completed IT)~ application fomr, two (2) copies <br />of Exhibits A-J, Exhibit L, Addendum 1, and appropriate sections of 6.5 (Geotechnical Stability Exhibit), as required, and a check for the <br />application fee descnbed ender (4) below. Exhibits should NOT be bound or iu a 3-ring binder; maps should be folded to 8 1/2" X 11" or <br />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 mformatiou described below. <br />1. Aoolicaut/ooerator or comnaov name (uame to be used oa oermkl: <br />~e+EM qV? ~o4NT~ <br />1.1 Type of organization (corporation, partnership, etc.): C-'n vT. R ~>ENG~ <br />1.2 I.RS. Tax ID No. or Social Security Number: 2.: ~' ~' ~ ~~' <br />2. OoeraHou uame (ok. mine or sRe uame): PA ANTOM ~w+Y o P1 ~ 1 <br />3. Permitted acreage (new or eaisthn¢ skel: 9 8 permitted acres <br />3.1 Change in acreage (+) o sores <br />Total Acreage in Permit Area 9~ acres <br />4. Fees: <br />4. ] New Application: .~};996~99~-~nplication fee <br />Amendment Fee (C.R.S. 34-32.5-125(II)): -37t4tj9' application fee <br />4.2 Conversion Fee (from 110d to 110 8S 75.00 conversion fee (Rule 1.11.2(2)) "C2 ~/' 18$ •O O <br />6. Primary rnmmoditie(sl to be mined: QohD Ptr F12a 4rti <br />5.1 Incidental commoditie(s) to be mined: 1. / lbs/Tons/vr 2. / Ibs/Tons/vr 3. ! lbs/fons/vr <br />4. / lbslfons/vt 5. / lbs/Tons/vr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: ~On.o M/4\+~lri ao.nrG.6. <br />Anticipated end use of incidental commoditie(s) to be mined: <br />