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IVISION OF rv11NERALS AND GEOLOGY III 1111111UIII1 ~~~ ~e;~e/~ <br />Drpalh m•nf of N,Ilurll RCiUUrCei V ,j <br />I{ I i ~hermdn SL, Room '_ I S SFp1 D I V I S I O N l <br />Denvrr, Giluradu Ill)21ll <br />rhunrt: noel nr,a-ISh; ~ M I N E RA L <br />F.~x.1IUJIlH'_~+111ffi <br />A 11'1 rr p~ ~~~bq o ~0 F~ G E O L O G <br />®~'YrG~~rl-~V~ CONSTRUCTIONhI.>TERIALS M~ra(4$y~s 0.ECLAMATIC <br />I'UBLYC FILE COPY MINING•SAFE' <br />nni~ll REGULAR([12)OPERATION ~f~y <br />FILE: r•t-/~f~~f-psi RECLAhIAT10N PERMIT APPLICATION FORM Clulvon~en: <br />SI7"E; (~ E /~f~ Creq E. Walther <br />:~.C r `j r- ' ~ pM~~D~~~~ E.eculive Direcwr <br />CHECK ONE: New .4 lication (Rulz l .a.~) ~ Amendment A lication Rule 1.10'licnae~ 9. tong <br />PP PP ( division Director <br />Conversion Application (Rule !.I 1) <br />Permit a tit -~-fj~-_ (provide for Amendments and Conversions ofexisting permiu) <br />The application for a Construction Materials Regular 112 Operation Reclamation Permit contains three major parts: (I) the application forth; <br />(2) Exhibits .4-S, Addendum I, any sections of Exhibit 6.5 (Geotechnical Stability Exhibit; and (3) the application fee. When you submit your <br />application, be sure [o include one (I} cnmolete sinned and notarized IVORY ORIGINAL and four (4) copies of the completed vo <br />application form, five (5) copies of Exhibits A-S, Addendum I, appropriate sections of 6.5 (Geo[echnical Stability Exhibit, and a check for <br />the application fee described undzr Szc[ion (~) below. Exhibits should NOT be bound or in a 3-ring binder; maps should be folded to <br />8 I!2" \ I I" or 8 l/2" )C Id" size, To expedite processing, pleasz provide the information in the format and order described in this form. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, io the space provided, ALL information requested below. <br />1. A-pplicanUoperator or company name (name to be used on permit): <br />I.1 Type of organization (corporation, partnership, etc.): D„ P ~ J »PV C r~. <br />1.2 f.R.S. Tax I.D. No. or Social Security Number: _,~' ~~ -_5 ~ 3 d <br />2. Operation name fait, mine or sitz numz <br />3. Permitted acreage (new or existin¢ site): 3 ~ ycl permitted acres <br />3.1 Change in acreage (+) ~ 9 ~~n acres <br />3:2 Total acreage in permit area ~5..~f ~ ~ acres <br />4. Fees <br />3.1 New Application SI-875.00 applicarion fee <br />i.? New Quarry .Application 52.325.00 quarry application <br />'t.3 Milling Application (Non•DMO) $3.100.00 milling application <br />3.~ Amendment Fee $1.550.00 amendment fee <br />4.5 Conversion to 112 operation (;zI by statute) $1.875.00 conversion fee <br />5. Primary tom mnditie(s) to he mincd: ZD %' Ol (SYII! JP rl h DY'l~/7 L1~ <br />5.1 Incidental commoditie(s) to be mincd: 1d: 1. Ibs!!'ons/vr <br />3. // lbs(1'nn~r 4. / Ibs~l'onslyr <br />5? Amicipaced end use of primary commoditie(s) to be mined: <br />~ / Ibs/fons/vr <br />S. / Ibs/fons/vr <br />5.3 Anticipated end use of incidental commoditie(s) [o be mined: <br />