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<br />STATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />Department of Natural Resources <br />7 313 Sherman St., Room 215 <br />Denver, Colorado 80203 <br />Phone: (303) 866-3567 <br />FAX: (303) 832-8106 <br />FILE COPY <br />fOR SCANN/NG <br />CONSTRUCTION MATERIALS <br />REGULAR (112) OPERATION <br />RECLAMATION PERMTT APPLICATION FORM <br />RECEIVE! <br />'APR 19 200 <br />SDI V 1 SION OF <br />MINERALS <br />3 GEOLOGY <br />Division ~f Minerals and G a E c t A N A r I o N <br />IN ING•SAFETY <br />Bill Owens <br />Governor <br />Greg E. Walther <br />Executive Director <br />CHECK ONE: _ _ New Application (Rule 1.4.5) _ Amendment Applicafion (Rule 1.1 ichael B. Long <br />Division Director <br />~ Conversion Application (Rule 1.11) <br />Permit # M - 9 9 _ 0 2 4 __ (provide for Amendments d Conversions f existing permits) <br />The application for a Construction Materials Regulaz 112 Operation Reclamation Permit contains three major pazts: (1) the application form; <br />(2) Exhibits A-S, Addendum 1, any sections of Exhibit 6.5 (Geotechnical S[abilityExttibit; and (3) the application fee. When yuu submit your <br />application, be sine to include one (1) comolete sieved and notarized IVORY ORIGINAL and four (4) copies of the completed ivory <br />application form, five (5) copies of Exhibits A-S, Addendum 1, appropriate sections of 6.5 (Geotechnical Stability Exhibit, and a check for the . <br />application fee described ands 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 1CL" X 14" size. To expedite processing, please provide the information in the format and ordea described in this form <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, ALL information requested below. w- ~ / <br />AooGcantlooerator or comoanv name (name to be used on permit): C o s t i 11 a County '~ <br />1.1 Type of organization (carporadon,pazmership,etcJ: rnSTrr.t.e rntlntTVlzr,arl x uurnrR <br />1.2 I.R.S. Tax I.D. No. or Social Security Number: <br />2. <br />3. <br />Ooerationname(ait.mineorsitenamel: SAN ACACIO GRAVEL PIT <br />Permitted acreage (new or existing sitel: <br />3.1 Change in acreage (+) <br />3.2 Total acreage in Permit area <br />4. Fees: <br />4.1 New Application <br />4.2 New Quany Applicaton <br />4.4 Amendment Fee <br />4.5 Conversion to 112 operation (set by statute) <br />5. Primarvcommoditie(s)tobemined: SAND GRAVEL <br />5.1 Incidental commodifie(s) to be mined: 1. 14 0 , 0 0 0 lbs/I'ons/vr <br />3. / lbsi I'onslyr 4. / lbs/I'ons/kr <br />$ . 04 permitted acres <br />6 7 .6 2 acres <br />7 5 . 6 6 acres <br />$2.344.00 application fee <br />$2.906.00 quarry application <br />$1.938.00 amendment fee <br />$2.344.00 conversion fee <br />2. / Ibs/Tons/vr <br />5. / lbs/Tons/vr <br />5.2 Anticipated end use of primary commodifle(s) to be mined: R 0 A D BAS E <br />5.3 Anficipated end use of incidental commodifie(s) to be mined: <br />