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F CO~OI~.DO <br />DIVISION OF MWERALS AND GEOLOGY <br />Depzrment of Natural Resources <br />13[3 Sherman St., Room 215 <br />Denver, Colorado 80203 <br />Phone: (303) 866-3567 <br />FAX: (303) 832-8106 <br />FEB 2 4 2003 <br />Division ~f Minerals and Geology <br />CONSTRUCTIOti MATERIALS <br />LLVIITED L~IPACT (110) OPERATIO\' <br />DIVISION OF <br />A4INERALS <br />GEOLOGY <br />RECLAMATION <br />MIN ING•SAFETY <br />- Bill Ovens <br />RECLAbIATION PER\IIT APPLICATION PORr1I eo~emor <br />Greg E. Walther <br />Executive Dir¢clor <br />Michael B. Long <br />K ONE: _; New Application (Rule 1.4) .. Conversion Application (Rule 1°~ ls]on Do-e~mr <br />R Amendment Application (C.R.S. 34-32.5-110) <br />Permits M -.1984=II7 (provideforAmendmentsandConcersionsofexisfingpermits) <br />plication for a Construction Materials Limited Impact (110) Operaflon Reclamation Permit contains tlueemajor parts: (1) the application form; <br />tibi[s A-7, Exhibi[L, Addendum 1, any sections ofExhibii 6.5 and Geotechnical Stabi]ityExhibit, as required by the Office, and outlined in Rules <br />2, 6.3, 6.5, and 1.6.2(1)(b); and (3) the application fee. When you submit your application, be sure to include orfe (1) complete signed and <br />ed IVORY ORIGL~TAL and one (1) copy of the completed Ivorv application form, hvo (2) copies of Exhibits A-J, Exhibit L, Addendum 1, and <br />riate sections of 6.5 (Geotechnical StabilityExhibit), as required, and a check for the application fee described under (4) below. Exhibits should <br />reboundorina3-ring binder; maps shouldbefoldedto8l/2"X11"or81i2"X14"size. To expaditeprocessing,pleasepro~idetheinformation <br />otTna[ and order described in this form. <br />GEIQERAL OPERATION liv'FORMATION _ _- _ <br />Type or print clearl}'> in the space provided, ALL information described below. ' <br />inHlicant/operator or comHanv name (name to be used on Hermit): Fremont County Board of Commissioners <br />.1 T}peoforganization(corporation,paztnership,etc.): Government Aeencv <br />.2 LR.S. Tax ID No. or Social SecurityNumber: ~ <br />perationname(pi[,mineorsitename): _ Fremont County Pit -District 1/3 <br />?ermined acreage (nely or eaistin¢ site): <br />i.l Changein acreage (+) <br />Total Acreage in Permit Area <br />'ees: <br />i.l New Application: <br />Amendment Fee (C.R.S. 34-32.5-125(11)): <br />'.2 Com•ersion Fee (from I l Od to 110 5875.00 conversion fee (Rule 1.11.2(2)) <br />~ 6 _ permitted acres <br />2.3 acres <br />9.9 acres <br />51.094.00 application fee <br />5719.00 application fee <br />?rimarvcommoditie(sltobemined: Road Materials/Gravel <br />>.I Inciden[alcommoditie(s) to be mined: 1. l0,OQ0 $F3s{'I'onshT) 2. / Ibs/Tonshr 3. / lbs/Tonshr <br />4. / lbs/IonshT 5. / Ibs/I'ons/c- <br />~'L Anticipated end use of primary commoditie(s)[obemined: Road Materials/Gravel <br /> <br />3 Anticipated end use of incidental commodities} to be mined: <br />N/A <br />