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I _- . >- <br />Y/~ <br />NOV 19 2003 (~ ~~ <br />/ lAl ~ ~F ~~ i •sio a Ian e°lo <br />DIVISION:OE;I~INERAtS AND GEOLOGY <br />Department of Natural Resources ~ ~ °° <br />'V~h'~~~ <br />1313 She!r((i~gr c,~RQQoo rgtg <br />Denver, Cblbi~do`alY2~UUJ 1 D I V l S l O N O F <br />T 92003 MINERALS <br />Phone: (303) 866-3567 C 1 2 <br />F ), CONSTRIICTIONMATE1tIAIS & <br />~~ ~~~Y"o1c- G E O L O G Y <br />LIIIIITED IMPACT (710) OPERA•1~ft~P° °}Minerals and Geolog~r R E C L A M A T I O N <br />fQiR SCANN/N~ ~ MIN ING•SAFETY <br />CLAII+IATION PERMIT APPLICATION FOBM <br />aal owes <br />Governor <br />/~ Greg E. Walther <br />CHECK ONE: ' v There is a FDe Number Already Assigned to ttis Operat~n ExeMive Director <br />Rauld W. Cattany <br />Perit # M D,~-~,_-~ (Please reference the Erie number c»tr'esfly assigned to this operation) Aping Division Director <br />New Application (Role 1.4.5) ~ Ain~dmeit Application (Role 1.10) <br />Conversion Application (Ars)e 1.11) <br />Permit # ~Iv _~~-,~ far Amendments and Conversions of e~sting permits) <br />'m- ~qs~- ~a ,~~ <br />The applicaicn for a Construction Materials Limited Impact (110) Operatics Reclamation Pemut contains three major parts: (1) the <br />application form; (2) Exhibits A-J, Exhibit L, Addendum 1, any sections ofExhibit 6.5 and Geotec~nical Stability Exhibit, as required by the <br />Office, and outlined in Rules 6.1, 6.2, 6.3, 6.5, and 1.6.2(1)(6); and (3) the application fee. When yon submit your application, be sure to <br />include one (1) complete signed and notarized IVORY ORIGINAL and tie (1) copy of tl~ completed h'orv application form, two (2) copies <br />of Exhibits A-J, Exhibit L, Addendumm 1, and appropriate sections of 6.5 (Geoteclmical Stability Exhibit), as required, and a check for the <br />application fee described under (4) Below. Exhibits should NOT be bennd or in a 3-ring binder; maps should be folded to 8 1/2" X 11" or <br />8 12" X 14" size. To expedite processing, please provide the i>d'ormation in the format and order described in this form. <br />GENERAL OPI'sRATION INFORMATION _ <br />or prfmt clearly, in the <br />ALL <br />1. ADDllcantloserator or rnmianv name (name to be used on Dermht): <br />I.I Type of organvetion (corporation, Partnership, etc.): DWNer o~ eY fir R <br />1.2 I.RS. Tax ID No. or Social Secirity Number: 2.: .5 a J - 'Yo"C - <br />2. Ocerathon name (iit, mine or site name): <br />3. Permitted aceage (new or emsthn¢ aitel: <br />3.1 Change in acreage (t) <br />3.2 Total Acreage m Permit Area <br />4. Fees: <br />4.1 New Application: <br />Amendment Fee (C.RS. 34-32.5-125(II)): <br />Q ~ "9~ !/~y'-~ )~'/ ~ r liermitted acres <br />'U "..' `{" acres <br />- 9. aerea <br />51.094.00 application fee <br />5719.00 application fee <br />4.2 Conversion Fee (from 110d to 110 875.00 conversion fee (Rule 1.11.2(2)) <br />5. Primary coimnoditie(sl to be mined: d/9/(/t7 CJ ~pN °L <br />5.1 Incidental commoditie(s) to be mined: 1. ! Ibs/Tons/vr 2. _ / Ibs/T'ons/vr 3. / Ibs/Tons/vr <br />N~~) ~ 4. / Ibs/fons/vr 5. ' / Ibs/1'olis/vr <br />5.2 Anticipated wd use of primary commoditie(s) w be mined: l34 ~ ~. ~ ~ ill R JV ~ ATE r i ~ <br />Anticipated end use of incidwtal commoditie(s) to be mined: NGNP <br />ek' <br />