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TATE OF CO~;OIZf~DO <br />D1VISIUV OF MINERALS AND GEOLOGL~ECEIVED <br />Depzrtment of Natural Resources R <br />1313 She: man St., Room 215 _ FEB ~ 4 ~^^~ <br />W <br />Denveq Colorado 80203 CD <br />Phone: (303) 866-3567 <br />FAX: (303) 832-8106 <br />f Minerals and Geo !if <br /> Division o <br /> CONSTRUCTION bIA <br />RECEIV~u <br />FF9 2 1 2003 <br />CLE ist :3 RdCJRt`ER <br />LLIIITED LIiPACT (110) OPERATION <br />DIVISION OF <br />MINERALS <br />GEOLOGY <br />RECLAMATION <br />MIN ING•gAFETY <br />- Bill Owens <br />RECLAMATION PERb'SIT APPLICATION FORbI governor <br />Greg E. Wakher <br />Executive Director <br />- Michael 8. Long <br />K OtiB: Nesv Application (Rule 1.4) _-Conversion Application (Rule {~~ ls)on Director <br />% Amendment Application (C.R.S. 34-32.5-110) <br />Perini[ r M -.1984-117 (provide for Amendments and Conversions of existing permits) <br />plication for a Construction Materials Limited Impact (110) Operation Reclamation Permit contains three majorparts: (1) the application form; <br />libits A-J, Exhibit L, Addendum 1, any sections of Exhibit 6.5 and Geotechnical StabilityExhibit, as required by the Office, and outlined in Rules <br />z, 6.3, 6.5, and 1.6.2(1)(p); and (3) the application fee. When }'ou submit }'our application, be sure to include ode (1) complete signed and <br />ed IVORY ORIGLITAL~and one (1) cop}' of the completed Ivorv applicaion form, hvo (2) copizs of Exhibits A-J, E~ibit L, Addendum I, and <br />riate sections of 6.5 (Geotechnical StabilityExhibiQ, as requ'ued, 2nd a check for the application fee described under (4) below. Exhibits should <br />le bound or in a 3-ring binder; maps should be folded to 8 12" X 11" or 8 1/2"X 14"size. To expediteprocessing, pleasepro~ide the information <br />'ormat and order described in this form. .. <br />GEIQERAL OPERATION LtiTFORMATION -._ _ <br />Type or print clearly, in the space provided, ALL information described below. ' <br />~pplicanUoperator or company name (name to be used on permit): Fremont County Board of Commissioners <br />.1 T}peoforganization(corporation,partnership,etc.): Government Agency <br />.2 I.R.S. Tax ID No. or Social SecurityI~TUmber: - ' <br />)peration name (pit. mine or site name): <br />?_e_rmitted acreage (nevc or existing site): <br />i.l Change in acreage (+) <br />Total Acreage in Pernut Area <br />'cgs: <br />Ll <br />~ '~.2 <br />Pit -District lf3 <br />New Application: <br />Amendment Fee (C.R.S. 34-32.5-125(II)): <br />Com'ersien Fee (from 110d to I10 5375.00 conversion fee (Rule 1.11.2(2)) <br /> <br />7 6 permitted acres <br />2.3 <br /> acres <br />9.9 acres <br />51.094.00 application fee <br />5719.00 application fee <br />ariman•commoditie(s}tobemined: Road Materials/Gravel <br />i.l Incidental commoditie(s) to be mined: 1. 10 , Oq0 ~4e'Ys~I'onshx) 2. / lbs/ponshr 3. / Ibs/I'onshx <br />4. / ]bslI'onshx 5. / 1bsfI'onshx <br />..2 Anticipated end use of primarycommoditie(s)tobemined: Road Ptaterials/Gravel <br />..3 Anticipated end use of incidental commoditie(s) [o be mined: N/A <br />