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STATE OF COt;ORA-DO <br />DIVISION OF MINERALS AND GEOLOGY <br />Depxrment of Natural Resources <br />7313 Shermzn St., Room 215 <br />Denveq Colorado 80203 <br />Phone: (303) 866-3167 <br />FAX: (303) 832-8106 <br />CONSTRUCTION hLATERIALS <br />LLrIITED LIIPACT (110) OPERATION <br />DIVISION OF <br />MINERALS <br />GEOLOGY <br />RECLAMATION <br />MI NING•SAFETY <br />Biil Owens <br />RECLAMATION PER`1IT APPLICATION FORbI Governor <br />Greg E. Watcher <br />Executive Director <br />- Michael 8. long <br />K ONE: New Application (Rule 1.4) .. Conversion Application (Rule ~1 i~°p olreowr <br />% Amendment Application(C.R.S.34-32.5-110) <br />Permit;" M --1984-1.17 (provide for Amendments and Conversions of existing permits) <br />plication for a Construction Materials Limited Impact (110) Operation Reclamation Permit contains threemajorpazts: {1) the application form; <br />iibits A-I, Exhibit L, Addendum 1, any sections of Exhibit 6.5 2nd Geotechnical StabilityExhibit, as required by the Office, and outlined in Rules <br />2, 6.3, G.S, and 1,6.2(1)(b); and (3) [he application fee. `Vhen you submit your application, be sure to include otfe (1) comniete siened and <br />ed IVORY ORIGI~i'AL 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 StabilityExhibiQ, as required, and a check for the application fee described under (4) below. Exhibits should <br />~e bound or in a 3-ring binder; maps should be folded to 8 1/2" X 11" or 8 1/2" X 14"size. To expediteprocessing,please provide the information <br />brmat and order described in this-form. <br />GENERAL OPERATION h\'FORMATION _ __ ., <br />Type or print clean}', in the space provided, ALL information described belovv~. <br />t~plicant/onerator or company name (name to be used on Hermit); Fremont County Board of Commissioners <br />'..1 Type oforganiza[ion (corporation, partnership,e[cJ: Government l~eencv <br />.2 LR.S.Tax1DNo.orSocialSecurityNumber: 84-6000765 <br />perationname(pi[.mineorsitename): _ Fremont County Pit -District ll3 - <br />?ermined acreaee (new or e?.istin~ site): 7 6 permitted acres <br />i.l Change in acreage (+) 2.3 acres <br />Total Acreage in Permit Area 9.9 acres <br />'ees: <br />i.l New Application: 51.094.00 application fee <br />Amendment Fee (C.R.S. 34-32.5-125(TI)): 5719.00 application fee <br />'.2 Conversion Fee (from 110d to 110 5875.00 conversion fez (Rule 1.11.2(2)) <br />.'rimarycommoditie(sltobemined: Road rlaterials/Gravel <br />i.l Incidental commoditie(s)[o be mined: 1. l0, OQ0 ~F~»-41'onsla) 2. / Ibs(fonshr 3. / lbs(Ions/vr <br />4. / lbs(fOnS/Vr 5. / Ibs/Tons/~r <br />~2 Ar,ticipatedenduseofprimarycommoditie(s)tobemined: Road Materials/Gravel <br />3.3 Anticipated end use of incidental commoditie(s) to be mined: N/A <br />