_REVISION - M1978107

• Permit No: M1978107
• IBM Index Class Name: Revision
• Doc Name: EXHIBIT A LEGAL DESCRIPTION
• Type & Sequence: AM2
• Media Type: D
• Archive: No

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CONSTRUCTION MATERIALS RESOURCES
REGULAR OPERATION (112)
RECLAMATION PERMIT APPLICATION FORM Roy Roma
Governor
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Michael R lonti
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CHECK ONE: New Application (Rule 1.4. 5) _X Amendment Application (Rule 1 . 10)
Conversion Application (Rule 1. 11)
Permit 1 M - 78 - 107 ( provide for Amendments and Conversions of
existing permits)
The application for a Regular 112 Operation Reclamation Permit contains three major parts: ( 1)
the application form; (2 ) Exhibits A-S, Addendum 1, any sections of Exhibit 6. 5 (Geotechnical
Stability Exhibit; and (3) the application fee. When you submit your application, be sure to
include one (1) complete signed and notarized IVORY ORIGINAL and four (4 ) copies of the completed
ivory application form, five (5) copies of Exhibits A-S, Addendum 1, appropriate sections of 6.5
(Geotechnical Stability Exhibit, and a check for the 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"
or 6 1/2" X 14" size. To expedite processing, please provide the information in the format and
order described in this form.
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GENERAL OPERATIONi INFORMATION
Type or print clearly in the space provided the information requested below.
1. Applicant/operator or company name (name to be used on permit) :
MONTEZUMA COUNTY
1. 1 Type of organization (corporation, partnership, etc. ) : (1,011NTY CO Vl'RNM ENT
1 .2 I .R.S. Tax I.D. No, or Social Security Number: 84-6000786
2. Operation name (pit, mine or site name) : _��L LI7:_L.YPANSTON
3. Permitted acreage (new or existing site) 13 . 29 permitted acres
3. 1 Change in acreage (+ or -) 40 . 51 acres
3.2 Total acreage in Permit area 51. 80 acres
4 . Fees:
4. 1 New Application $1,875.00 application fee
4.2 New Quarry Application $2,325.00 quarry application
4.3 Milling Application (Non-DMO) $3, 100.00 milling application
4 . 4 Amendment Fee $1,550.00 amendment fee
4. 5 Conversion to 112 operation (net by statute) 51,875.00 conversion fee
Primary commodities) to be mined: GRAVEL 50 ,000 CUBIC YARDS per yr for 10 years
5. 1 Incidental commoditie s) to be mined: 1 . - lbs/Tons/yr
2. / lbs/Tons/yr 3. / lbs/Tons/yr
4. / lbs/Tons/vr 5. / lbs/Tons/vr
5.2 Anticipated end use of primary commodities) to be mined: ROAD CONSTRUCTION
5.3 Anticipated end use of incidental commoditie s) to be mined: N/A