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875 ~° ~ <br />~ ~ ~ ~113~ <br />~Tt~TE OF C LORAD <br />^IVISION OF MINERALS AND GEOLOGY <br />Department ui N,vural Resources <br />I it f Sherman $t., R,xlm ? 1 i <br />Denver, Colorado HU_'U) <br />Phone: I7U71 tl6G3.i R7 <br />FAx: (303) R3'_~H 106 <br />' a~~r~j,l~..n <br />,~u~. u n <br />&~eo~o9Y <br />~~ <br />DIVISION O <br />MINERAL <br />bt <br />GEOLOG' <br />RECLA MATIOt <br />FIINING•$AFE 7' <br />CONSTRUCTION MATERIALS <br />REGULAR (112) OPERATION DMStono( <br />RECLAh1AT10N PERMIT APPLICATION FORM <br />CHECK ONE: _ New Application (Rule 1.4.5) _ Amendment <br />~ Conversion Application (Rule 1.11) <br />Permit # M -,~~- 025 -_ (provide for Amendments and Conversions of existing <br />The application for a Construction Materials Regular 112 Operation Reclamation Permit contains three major <br />(2) Exhibits A-S, Addendum 1, any sections ofExhibit 6.5 (Geotechnical Stability Exhibit; and (3) the applicat <br />application, be sure to include one (1) com~te si¢ned and notarized IVORY ORIGINAL and four (4) <br />application form, five (5) copies of Exhibits A-S, Addendum 1, appropriate sections of 6.5 (Geotechnical S <br />the application (ee described under Section (4) below, Exhibits should NOT be bound or in a 3-ring bit <br />8 1/2" X 11" or 8 1!2" X 14" size. To expedite processing, please provide the information in the format an. <br />811 Owens <br />Governor <br />Greta E. Walther <br />Execmive Director <br />(Rule I.IO~j'cnael B. Loral; <br />wision Duenor <br />tarts: (1) [he application form; <br />m fee. When you submit your <br />;opies of the completed Ivory <br />Ibiliry Exhibit, and a check for <br />ter; maps should be folded to <br />order described in this form. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, io the space provided, ALL information requested be ow. <br />1.1 Type of organization (corporation, partnership, etc.): <br />I? I.R.S. Tax I.D. No. or Social Security Number: <br />2. Operation name /ait, mive or site name): <br />3. Permitted acreage (pew or e:istioe sitel: <br />3.l Change in acreage (+) <br />3.2 Total acreage in Permit area <br />4. Fees: <br />4.1 New Application <br />4? New Quarry Application <br />4.3 Milling Applica[ion (Non-DMO) <br />4.4 Amendment Fee <br />4.5 Conversion to 112 operation (set by statute) <br />5. Primary commoditie(s) to be mined: Sand GLavE'1 <br />5.1 Incidental commoditie(s) to be mined: 1. Netne Ibs/fons/vr 2. <br />3. / Ibs/I'ons/vr 4. ! Ibsll'ons/vr 5. <br />5.2 Anticipated end use of primary commoditie(s) to be mined: Highway Constn <br />permitted acres <br />30.53 acres <br />40.00 acres <br />application fee <br />quarry application <br />milling application <br />amendment fee <br />lonversion fee <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: none to benone to ttLined~ <br />