REV93285

• Permit No: M1977053
• IBM Index Class Name: Revision
• Doc Date: 9/26/1996
• Doc Name: CONSTRUCTION MATERIALS REGULAR OPERATION 112 RECLAMATION PERMIT APPLICATION FORM
• Type & Sequence: CN1
• Media Type: D
• Archive: No

TATE OF COLORADO
DIVISION OF MINERALS AND GEOLOGY
Depanmenl of Natural Resources
1313 Sherman St., Room 215
Denver, Colorado 80203
Phone: [phone]
FA%: (303) 8328106
RECE11/~.D
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DEPARTMENT OF
NATURAL
RESOURCES
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'~' SEP 2 G 1996
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'" MINERALS 8 GEO~OGv
CONSTRUCTION MATERIALS
REGULAR OPERATION (112)
RECLAMATION PERMIT APPLICATION PORN
Roy Romer
Governor
lames S Lochhead
Executive Director
Michael B. loop
Division Director
CHECK ONE: New Application (Rule 1.4.5) Aaeadaent Application (Rule 1.10)
R Conversioa Application (Rule 1.11)
Permit # M - 77 - 053 -_ (provide for Auead~ents and Conversions of
existing permits)
The application for a Regular 112 operation Reclamation Permit contains three major parts: (1)
the application form; (2) Exhibits A-S, Addendum 1, any sections of Exhibit 6.5 (Geotechnical
Stability Exhibit; and (3) the application fee. When you submit your application, be sure to
include one (1) complete signed and notarized IVORY ORIGINAL and four (4) copies of the completed
ivory application form, five (5) copies of Exhibits A-S, Addendum 1, appropriate sections of 6.5
(Geotechnical Stability Exhibit, and a check for the application fee described under Section (4)
below. Exhibits should not be bound or in a 3-ring binder; maps should be folded to 8 1/2" X 11"
or 8 1/2" X 14" size. To expedite processing, please provide the information in the format and
order described in this form.
GENERAL OPERATION INFORMATION
Type or print clearly in the space provided the information requested below.
1. Applicant/operator or company name (name to be used on permit):
Asphalt Constructors. Inc.
1.1 Type of organization (corporation, partnership, etc.): Corporation
1.2 I.R.S. Tax I.D. No. or Social Security Number:
2. Operation name (pit, mine or site name): Smith Pit
3. Permitted acreage (new or existing site) 6.0 permitted acres
3.1 Change in acreage (+ or -) 24.4 acres
3.2 Total acreage in Permit area 30.4 acres
4. Fees•
4.1 New Application 51,875.00 application fee
4.2 New Quarry Application 52,325.00 quarry application
4.3 Milling Application (Non-DHO) 53,100.00 milling application
4.4 Amendment Fee 1 550.00 amendment fee
4.5 Conversion to 112 operation (set by statute) __~conversion fee
I ~S `i `J
5. Primary commoditie(s) to be mined: Sand Gravel '
5.1 Incidental commoditie(s) to be mined: 1. - lbs/Tons/vr
2. / lbs/Tons/yr 3. / lbs/Tons/yr
4. / lbs/Tons/vr 5. / lbs/Tons/vr
5.2 Anticipated end use of primary commoditie(s) to be mined: Asphalt. Roadbase
5.3 Anticipated end use of incidental commoditie(s) to be mined: