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99 ~~ I~ ~~SUq q~- <br />STATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY ~, c <br />Dcpanment of Nmural Re>ources <br />1313 Sficrm, n SL, Room ~, 5 RECEIVEC ~~~~ <br />Denvcr, Colorado 80203 r <br />Phnno; (}031 866-3567 <br />FAY:13U 31 b3?-8106 JAN 2 p ~ggg DEPARTMENT OF <br />Division of Minerals d c,eolo NATURAL <br />CONSTRUCTION *R*~pTaT~S 9Y RESOURCES <br />REGULAR (112) OPERATION <br />kov Romer <br />RECLAMATION PERMIT APPLICATION FORM Governor <br />lames 5. Lochhead <br />Execuu.e Dtrecor <br />rt,u~hael 8. Long <br />Dimvon D~reaor <br />CHECK ONE: Neon Application (Rule 1.4.5) Amendment Application (Rule 1.10) <br />Conversion Application (Rule 1.11) <br />Permit # ~-~_- ~ 7 -_ (provitle for Amendments and Conversions of existing <br />permits) <br />The application for a Construction Materials Regular 112 Operation Reclamation Permit contains <br />three major parts: (1) the application form; (2) Exhibits A-S, Addendum 1, any sections of <br />Exhibit 6.5 (Geotechnical Stability Exhibit; and (3) the application fee. When you submit your <br />application, be sure to include one (1) complete sinned and notarized IVORY ORIGINAI. and four (4) <br />copies of the completed Ivorv application form, five (5) copies of Exhibits A-S, Addendum 1, <br />appropriate sections of 6.5 (Geotechnical Stability Exhibit, and a check for the application fee <br />described under Section (4) below. Exhibits should NOT be bound or in a 3-ring binder; maps <br />should be folded to 8 1/2" X 11" or 8 1/2" X 14" size. To expedite processing, please provide <br />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 <br />2 <br />3 <br />9 <br />5 <br />1.1 Type of organization (corporation, partnership <br />1.2 I.R.S. Tax I.D. No. or Social Security Numb C <br />Oceration same (vit, mine or site name): ~,J/b <br />Permitted acreage (nex or existino site): <br />3.1 Change in acreage (+) <br />3.2 Total acreage in Permit area <br />Fees: <br />4.1 New Application <br />4.2 New Quarry Application <br />9.3 Milling Application (Non-DMO) <br />9.4 Amendment Fee <br />4.5 Conversion to 112 operation (set by s//tatute) <br />Pr+T~*v commoditie(s) to be mined: i1 ~ MC <br />S1,875.00 application fee <br />52,325.00 quarry application <br />53,100.00 milling application <br />51.550.00 amendment fee <br />S1,E75.00 conversion fee <br />5.1 Incidental commoditie(s) to be mined: 1. - /~q DOO Tr3~/Tons/vr <br /> 2. / lbs/ Tons/vr 3. / lbs/Tons/vr <br /> 4. / lbs/ Tons/vr 5. / lbs/Tons/vr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: a s~ -ra..e/ <br /> <br />9. g permitted acres <br />/3. 7 acres <br />~3. ~ d acres <br />