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1 <br />~1 <br />I~ <br />1 <br />1 <br />1 <br /> <br />II <br />1 <br />I <br />Richartl D. Lamm <br />Governor <br />III IIIIIIIIIIIII III <br />999 <br />DEPARTMENT OF NATURAL RESOURCES <br />Davitl H. Gercnea Eaeculive Direcror <br />MINED LAND RECLAMATION DIVISION <br />DAVID C. SHELTON, Director <br />REGULAR (112) PERMIT <br />APPLICATION FORM ~ pN 1 51986 <br />~IIINF.D -. t~ -~tuUlq-t~nglplTWN <br />Application for Mining and Reclamation Permit, Pursfir~ct;-~SVtC~~2N~~~~~73, 34832-101, <br />et s~ce as amended. <br />r'Y1-XD "~a',L <br />(Type of Print Clearly) <br /> <br />1. Name of Operation <br />(pit, mine or site name) Fremont County, Colorado <br />2. Name of Applicant/Operator Fremont Paving and Redi-P1ix, Inc. <br /> (name to be used on permit) <br />3. Address and Phone Number of P.O. Box 841, Canon City, CO 81212 <br /> Local Office I (303) 275-3264 <br />4. Address and Phone Number of (same as local office) <br /> General Office <br />5. Name and Phone Number of Person Phyllis Ary <br /> Staff Members Should Contact f (303) 275-9579 <br />6. Parent Corporation, If Any (none) <br />(include name and address) <br /> 7. Owners} of Record of Affected l.) Fremont Paving and Redi-Mix, Inc. <br />' Land (surface area) I 2.) John L. Ary and Phyllis Ary <br /> (if more than two, list in <br />t EXHIBIT P) <br /> 8. Owner(s) of Substance to be 1.) Fremont Paving and Redi-Mix, Inc. <br />' Mined (if more than two, list I 2.) John L. Ary and Phyllis Ary <br /> in EXHIBIT P) <br />1 <br /> <br />423 Centennial Building, 1313 Sherman Street Denver, Colorado 00203 Tel. (30:x) 866-3567 <br />