2003-11-20_REVISION - M1986048 ‎(2)‎

• Permit No: M1986048
• IBM Index Class Name: Revision
• Doc Date: 11/20/2003
• Doc Name: 2nd Submittal Conversion Application
• From: Washington County
• To: DMG
• Type & Sequence: CN1
• Media Type: D
• Archive: No

STATE OF /a~r~ ~u.~om~ ~~..Q
COLORADO
DIVISION OF MINERALS AND GEOLOGY
Department of Natural Resources
1313 Sherman SL, Room 215
Denver, Colorado 80203 ~~ p ~ ~0 ®~~J
L {~ ((
DIVISION O f
Phone: [phone] ®
FAX: [phone]
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CONSTRUCTION MATEBIALS RECLAMATION
MINING • s A F E r Y
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\50n N PEB s
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CLAMATIO
NIITAPPLICATION FORM
RE
otN"peta
o~ covemor
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0~~`S` Greg E. Walther
Executive Director
CHECK ONE: Them is a Fie Number Already Assigned to this Operation Ronald w. canany
Petmit # M -_-_-_ (Please reference the file n~ber etmenfly assigved [o this operation) Acing Division Director
New Application (Role 1.4.5) _ Amendment Application (Mule 1.10)
Conversion Applicatioq (Rule 1.11) ~/~ / /
Permit # M -~-~~-~/(provide for Amendments and Conversions of elcisting permits) -' " ~ ` /
The application for a Conshaction Materials Regular 112 Operation Reclamation Permit contains three majorpaRs: (1) the app}ication farm;
(2) Exhibits A-S, Addendum 1, any sections of F.xhtbit 65 (Geotechoical Stabrlity Exhibit; and (3) ibe application fee. When yon submit your
application, be sme to i~hule one (1) comolete sianed and notarized IVORY ORIGINAL and one (1) copy of the completed I~ application
fatm, two (2) copies of Exhibits A-S, Addendum 1, appropriate sectitms of 6.5 (Geotechmcal Stability F.xhtbit, and a check for the application
fee descnbed under Section (4) below. Exhibits should NOT be bonad ~ in a 3-ring binder; maps should be folded to 812" X 11" or 8 1/2"
X 14" size. To expedite ptncessing, please provide die information in the fomtat and a~rdrs descr171ed in this form.
GENERAL OPERATION INFORMATION
Type or print clearly, in the apace provided, ALL information requested below.
1. Aonlicaat/otxrator or oomoanvname (name to be used on oermkl: ~,~r,, S l,', r~ ~ y~ (~ r1 r , E ~y~~
I.I Type of organization (corporation, parmersldp, etc.):
1.2 I.RS. Tax I.D. No, or Social Security Number:
y~I
2. Operation name fait, mine or site name): 1 V 1 Gh, ~~ ~-S b v~ Cs-rr~„~ r . ~ ~ : ~"
3. Permitted attests (new oc evatine site):
3.1 Change in acreage (+)
3.2 Total acreage in Pernt area
4. Fees:
4.1 New Application
4.2 New Qaatty Application
4.4 Amendment Fee
4.5 Conversion to 112 operation (set by statute)
~. Primary rnmmoditie(sl to be mined: /f, ~ "r F _
5.1 Incidental commodine(s) to be mined: 1. lYr/w e ~-~ /mU Ibs/Tonslvr
3. / lbs/Tons/vr 4. / Ibs/Tonslvr
5.2 Anticipated end use of primary commoditie(s) to be mined: o l
9 r permitted acres
y0 , U acres
y9 , y acrc~
$2,344.00 application fee
$2,906.()0 quarry application
$1,938.00 amendms;alfee
52.344.00 conversion fee
2. 1~; r ~ / 5joaz~lbs/Cons/vr
5. 1 IbslTonslvr
5.3 Anticipated end use of incidental commoditie(s) to be mined: