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~ 1 t~ <br />STATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />Department of Natural Resources <br />1313 Sherman St., Room 215 <br />Denver, Colorado 80203 <br />Phone: (303) 866-3567 <br />FAX: (303) 832-8106 <br />FI~.E COPY <br />fOR SCANNING <br />RECEIVED <br />MAY 0 2 2003 / <br />Division of Minerals and Geology <br />CONSTRUCTION MATEBIALS <br />REGULAR (112) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />CHECK ONE: ~_ There Ls a FDe N~er Already Assigned to tbia Operation <br />Permit # M - 83 - 106 __ (pie reference ~ file nmmber currently assigned to this operation) <br />!New Application (Rule 1.4.5) XX Amendment Application (Rule 1.10) <br />Conversion Application (Rule 1.11) <br />Permit # M - 83 - 106 -_ (pr+ovide for Amendments and Conversions of existing permitR) <br />D[VtS[ON OF <br />MINERALS <br />GEOLOGY <br />RECLAMATION <br />MI NtNG•SAFE7Y <br />Bill Owens <br />Governor <br />Greg E. Walther <br />Executive Director <br />Ronald W. Cattany <br />Acting Division DIrCCtOr <br />The application for a Canslmction Materials Regular 112 Operation Reclamation Permit contains three major paRS: (1) the application form; <br />(2) Exhibits A-S, Addendmm 1, a~ sedioas of Exlubii 65 (Geotechnical Stability Exhibit and (3) the application fee. When you submit your <br />application, be sme to include one (1) complete siffied and notarized IVORY ORIGINAL and one (1) copy of the completed ~ application <br />form., two (2) copies of Exhibits A-$ Addendum 1, appropriate sections of 6.5 (Geoteclmical Stability Exhibit, and a check for the application <br />fee describedunder Section (4) below. Exhibits shattldNOT be bound ar in a 3-ring binder; maps should be folded w 812" X 11" or 8 l/2" <br />X 14" size. To expedite processing, please provide the information in the format and order descnbed in this form. <br />GENERAI.OPERATION INFORMATION <br />Type or print charly, in the apace provided, AI;L information requested below. <br />I. AHHlicant/ocerator or comHanvname (name to be used on Hermit): Cheyenne County '~ <br />].1 <br />Type of organization(coriwration,partnership,etc.): Government <br />1.2 I.R.S. Tax I.D. No. or Social Security Number: <br />2. OHeratioHname(Hit.mineorsitename): Cheyenne County Pit No. 2 <br />3. Permitted acrea¢e (new oe evstine site): <br />3.1 Change in acreage (+) <br />3.2 Total acrease in Permit ar..a <br />4. Fees: <br />4.1 New Application <br />42 New Quarry Application <br />4.4 Amendment Fee <br />4.5 Conversion to 112 operation (set by statute) <br />35 permitted ages <br />30 acres <br />65 acre, <br />$2.344.00 application fee <br />52 906.00 quarry application <br />51.938.00 amendmcat fee <br />52.344.00 conversion fee <br />5. Primary rnmmoditie(s) to be mined: sand gavel <br />5.1 Incidental commoditie(s) to be mined: 1. , lbs/Tonst~r <br />3. / Ibs/Tons/vr 4. / Ibs/Tons/vr <br />2. / Ibslfons/vr <br />5. / IbslTons/vr <br />5.2 Anticipated endaseofprimarycommoditie(s)tobemined: Road development and improvements <br />5.3 Anticipated end ttse of incidental commoditie(s) to be mined: <br />