REV97054

• Permit No: M1985210
• IBM Index Class Name: Revision
• Doc Date: 1/24/1997
• Doc Name: CONSTRUCTION MATERIALS REGULAR OPERATION 112 RECLAMATION PERMIT APPLICATION FORM
• Type & Sequence: TR1
• Media Type: D
• Archive: No

DIVISION OF MINERALS AND GEOLOGY
Department of Natural Resources
1313 Sherman St., Room ?1 i
Denver, Colorado 80?07
Phone: [phone]
FAX: [phone]'.'-8106
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CONSTRIICTION NATER.7,ALS ;~, .:., _ -.•. ~~ --- .~
REGULAR OPERATION (112)
RECLAMATION PERMIT APPLICATION FORM
CHECK ONE•
Amendment
RADO
I I~~~~
3~J DEPARTMENT OF
NATURAL
RESOURCES
Roy Romer
Governor
lames S. lochhead
Ezecuuve Director
Mkhael B. Long
Dwision Direaar
(Rule 1.10)
11)
(provide for Amendm
existing permits)
The application for a Regular 112 Operation Reclamation Permit contains
the application form; (2) Exhibits A-S, Addendum 1, any sections of Exh.
Stability Exhibit; and (3) the application fee. When you submit your a,
include one (1) complete atoned and notarized IVORY ORIGINAL and four (4) ~
ivory application form, five (5) copies of Exhibits A-S, Addendum 1, apprc
(Geotechnical Stability Exhibit, and a check for the application fee descl
below. Exhibits should not be bound or in a 3-ring binder; maps should be
or 8 1/2" X 14" size. To expedite processing, please provide the informz
order described in this form.
-----------------------------
GENERAL OPERATION INFORMATION
and Conversions of
ree major parts: (1)
it 6.5 (Geotechnical
lication, be sure to
dies of the completed
date sections of 6.5
red under Section (4)
olded to 8 1/2" X 11"
.on in the format and
Type or print clearly in the space provided the information re sted below.
1. A licant o rotor or com an name (name to be used on permit):
-
c.
oc <. I ~ 1 r
1.1 Type of organization (corporation, partnership, etc.):

1.2 I.R.S. Tax I.D. No. or Social Security Number: -
2. Opera tion name (pit, mine or site name): 1 OG~- Z ~"~ ~

3. Permi tted acreaae (new or existing site) C7 permitted acres
3.1 Change in acreage (+ or -) ~ f~ 3 ~ acres
9 ~
3.2 Total acreage in Permit area acres
4. Fees:
4.1 New Application 1 97 .00 application fee
4.2 New Quarry Application 2 325.0 quarry application
4.3 Milling Application (Non-DMO) 3 100.00 milling application
4.4 Amendment Fee 1 50.00 amendment fee
4.5 Conversion to 112 operation (set by statute) 1 8 5.00 conversion fee
5. Primary commoditie(s) to be mined: 11 -' 1 CInr1~l~ ~n (s YZ
5.1 Incidental commoditie(s) to be mined: 1. - lbs Tons r
2. / lbs/Tons/vr 3. lbs Tons r
4. / 1bs/Tons/vr 5. lbs Tons r
5.2 Anticipated end use of primary commoditie(s) to be mined:r;l~ l~" 511E

5.3 Anticipated end use of incidental commoditie(s) to be mined:
New Application (Rule 1.4.5)
Conversion Application (Rule 1
Permit ~ ~-~-~Q-_