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<br /> <br />STATE OF COLORADO <br />^IVISION OF MINERALS AND GEOLOGY <br />DepJrlmenl ul NJlural Re50u4es <br />1! I J Sherman Sr., Room ? t i <br />Denver, Colorado HD?D3 <br />Phone: 1:071 n6G-3561 <br />FAX IlDA nJ_-21106 <br />CONSTRUCTION MATERIALS <br />REGULAR (l l2) OPERATION <br /> <br />DIVISION OF <br />MINERALS <br />GEOLOGY <br />R E C L A M A T I O N <br />MI NING•$AFETY <br />RECLAMATION PERMIT APPLICATION FORM s,ll ovens <br />Gnvemor <br />(;req E. Wdlcher <br />E+ecuuve D~renor <br />CHECK ONE: New A lication Rule 1.4.5 Amendment A lication Rule I.10 cnael e. tong <br />PP ( ) PP ( ~nnfon D~reaor <br />Conversion Application (Rule I.l 1) <br />Permi[ # M -~ 1 C1 1 _ (provide for Amendments and Conversions of existing permits) <br />The application for a Cortsvuction Mazerials Regular 112 Operation Reclamation Permit contains three major pare: (I) the application form; <br />(2) Exhibits A-S, Addendum I, any sections ofExhibit 6.5 (Geotechnical Stability Exhibit; and (3) the application fee. When you submit your <br />application, be sure to include one (I) complete signed and notarized IVORY ORIGINAL and four (4) copies of the completed Ivory <br />application form, five (5) copies of Exhibits A-S, Addendum 1, appropriaze sections of 6.5 (Geotechnical Stability Exhibit, and a check for <br />the application fee described under Section (4) below. Exhibiu should NOT be bound or in a 3-ring binder; maps should be folded to <br />8 12" X I I" or 8 1/2" X 14" size. To expedite processing, please provide the information in the format and order described in this form. <br />GENERAL OPERATION INFORMATION <br />Type or pript clearly, ip the space provided, ALL informatiop requested below. <br />1. Aoplicon!/ooentororcomoapYpame(eametobeusedopoermitl: ~.IIOeJ'~- GQ.icv~~+GnsieftlvtnP(~'~ <br />LI Tvpe of organization (corporarion, partnership, etc.): ~_ v,. , ~~u C.:n~ erlAMt~ __ <br />1 ~ LR.S. Tax LD. No. or Social Security Number: 4.`~' ~ 00-1 CO~ <br />2. Operatiop name foit, wipe or site name): ~OYI d~5 ~~, ~ # `~e6 ~ ~ <br />3. Permitted acreage fnew or existine site): <br />3.1 Change in acreage (+) <br />3.2 Total acreage in Permit area <br />4. Fees: <br />4.1 New Application <br />4.2 New Quarry Application <br />4.3 Milling Application (Non-DMO) <br />4,4 Amendment Fee <br />4.5 Conversion to 112 operation (set by statute) <br /> <br />5. Primary commoditie(s) to be mined: ~ r a r 1 C~ <br />5.1 Incidental commoditie(s) to be mined: I. Ibs/fons/vr <br />Q ~~ permitted acres <br />C~,C~i~ acres <br />`~'l-t_ acres <br />$1,875.00 application fee <br />$2,325.00 quarry application <br />$3,100.00 milling application <br />1550.00 amendment fee <br />.00 conversion ee <br /> <br />o / Ibslions/vr <br />3. / Ibs/ions/vr 4. / Ibslfonslvr 5. ( ib onslvr p <br />5.3 Anticipated end use of primary commoditie(s) to be mined: J L(C"~` G ~ ~R~~i r a' ~ee RO cQ~S <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: <br />