REV105373

• Permit No: M1979166
• IBM Index Class Name: Revision
• Doc Date: 9/16/1997
• Doc Name: CONSTRUCTION MATERIALS REGULAR OPERATION 112 RECLAMATION PERMIT APPLICATION FORM
• Type & Sequence: CN1
• Media Type: D
• Archive: No

ii iiiiiiiiiiiiiiii ~

~~0371aov
)Zee# 03ZZ
STATE OF COLORADO
DIVISION OF MINERALS AND GEOLOGY
DeVanmenl Of Natural Resources R F C E I V F ~
I } 13 Sherman 51., Room 215
ncnvcr, Colorado fl0203 $EP 16 1997
1'honc: 13011 866-3567
FAX: [phone]-B 106
pplvicion o~ wl~norells K Ud~~oor
CONSTRUCTION MATERIALS-
REGULAR OPERATION (112)
RECLAMATION PERNIT APPLICATION FORM
~~~~
DEPARTMENT OF
NATURAL
RESOURCES
Roy Romer
Governor
lames 5. lochhead
Evecusive Director
michael B. Lang
Division Dueclor
CHECK ONE: New Application (Rule 1.4.5) Amendment Application (Rule 1.10)
~ Coaversioa Application (Rule 1.11)
Permit if M - /P -_~-_ (provide for Aseadaents and Convereionc 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 eianed 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 bQ used on permit):
1.1 Type of organization (corporation, partnership, etc.): Individual
1.2 I.R.S. Tax I.D. No. or Social Security Number: 5 ~3-5(o-Cff'3'~-
2. operation name (pit, mine or site name: Bennett~Gravel Pit
3. Permitted acreage (nYlN(kit existing site) 9.15 permitted acres
3.1 Change in acreage (+ or -) 22.A5 acres
3.2 Total acreage in Permit area 32.~-6_Q 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-DMO) 53,100.00 milling application
4.4 Amendment Foe 51.550.00 amendment fee
4.5 Conversion to 112 operation (set by statute) 51.875.00 conversion fee
5. Primary commoditie(sl to be mined: $dnd dnd GrdVel
5.1 Incidental commoditie(s) to be mined: 1. _ 1]Ofle - lbs/Tons/vr
2. / lbe/Tons/vr 3. / lbs/Tons/vr
4. / lbs/Tons/vr 5. / lbs/Tons/vr
5.2 Anticipated end use of primary commoditie(s) to be mined: COF15t1"UCt10f1
5.3 Anticipated end use of incidental commoditie(s) to be mined: Il.d.