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~ l ~, -- j ~~ / L~ /~S <br />STATE OF COLORADO <br />DIVISION OF MINERALSAND GE~,~E F~~E COPY I~•\~, <br />Department of Natural Resources <br />1313 Sherman S[., Room 215 / UN 0 5 2003 FOR SCANN/NG <br />Denver, Colorado 80203 - <br />Phone:(303)866-3567 <br />FAX: (303) 832-8106 Division of Minerals and Ceolopy <br />CONSTRUCTION MATERIALS <br />REGULAR (112) OPERATION ~ <br />RECLAMATION PERMIT APPLICATION FORM <br />DIVISION OF <br />MINERALS <br />GEOLOGY <br />RECLAMATION <br />MINING•SA FETY <br />eil I Owens <br />Governor <br />Greg E. Walther <br />Executive Director <br />CHECK ONE: _ New Application (Rule 1.4.5) ~ Amendment Application (Rule 1.1 ichael B. Long <br />ivision Director <br />Conversion Application (Rule 1.11) <br />Permit # M -~- 534 -, M _ (provide for Amendments and Conversions of existing permits) <br />The application for a Construcfion Materials Regulaz 112 Operation Reclamation Permit contains threemajorpaz[s: (1) the application form; <br />(2) Exhibits A-S, Addendum 1, any sections of Exhibit 6.5 (Geotechnical StabilityExhibit; and (3) [he application fee. When you submit your <br />application, be sure [o include one (1) complete siened and notarized IVORY ORIGINAL and four (4) copies of the completed Ivorv <br />applicafion form, five (5) copies of Exhibits A-S, Addendum 1, appropriate sections of 6.5 (Geo[echnical Stability Exhibit, and a check for the . <br />application fee described under Section (4) below. Exhibits should NOT be bound or in a 3-ring binder; maps should be folded to 8 1/2" X 11" <br />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 INFORMATION <br />Type or print clearly, in the space provided, ALL information requested below. <br />1. AoplicanUoperator or comoany name (name to be used on permit): Mountain Aggregates , Inc. <br />1.1 Type of organization (corporation, paztnership, etc.): <br />1.2 LR.S. Talc LD. No. or Social Security Number: <br />2. Operation name (pit, mine or site name): <br />3. Permitted acreage (new or existine site): <br />3.1 Change in acreage (+) <br />3.2 Total acreage in Permit azea <br />4. Fees: <br />4.1 New Application <br />4.2 New Quarry Application <br />4.4 Amendment Fee <br />Corporation <br /> <br />Empire Pit <br />4.5 Conversion to 112 operafion (set by statute) <br />5. Primary commoditie(sl to be mined: Sand <br />Gravel Rcad Base <br />5.1 Incidental commoditie(s) to be mined: 1. NSA - lbs/Tons/vr <br />3. / lbs/Tons/vr 4. / lbs/'I'ons/vr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: <br />106.79 permitted acres <br />+24.87 acres <br />131.66 acres <br />$2 344.00 application fee <br />52,906 00 quazry application <br />$1.938 00 amendment fee <br />$2 344.00 conversion fee <br />2. / Ibs/Tons/vr <br />5. / lbs/Tons/vr <br />Construction aggregates <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: None anti <br />