PERMFILE100233

• Permit No: M2005065
• IBM Index Class Name: Permit File
• Doc Date: 9/6/2005
• Doc Name: Reclamation Permit Application Form
• From: Jack Clark Jr.
• To: DMG
• Media Type: D
• Archive: No

tVIS10N OF MINERALS AND GEOLOGY
Department of Natural Resources
1313 Shmnan St., Room 215
Deriver, Cobrado 80203
Phone: [phone]
FAX: [phone]
LJ H E ~
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STATE OF COLORADO
t'•rlr t:..
- t.a i~ ~A
SEP 0 6 2005 ~
Disisisn of Minerals & Geology
CONSTRUCTION MATERIALS
LII121TED IMPACT (110) OPERATION
RECLAMATION PERMIT APPLICATION FORM ~
CHECK ONE: There ie a File Number Already Assigned to this Operation
COLORADO
DIVISION OF
MINERALS
GEOL&OGY
0.6ClAM ATION•MININ6
fATlTY•f CifiN CE
Bill Owens
Governor
Russell George
ExecuBve Director
Ronald W. Cattany
DNlslon Director
Natural Resource Trustee
Permit # ,~L.-_ _ _ (Please reference the file mtxnber currently assigned to this operation)
-*-New Applicatioa (Role 1.4.5) Amendment Application (Rule 1.t0)
Conversion Application (Rule 1.11)
Permit # ~4 -_ _ (provide for Amendments and Conversions of existing permits)
The application for a Construction Materials Limited Impact (I 10) Operation Reclamation Permit contains three major parts: (1) the
application form; (2) Exlu'bita A-7, Exhibit L, Addendum 1, any secrlone of Extlibit 6.5 and Oeotechnicai Stability Exhibit, ae required by
the OfSce, and outfitted in Rules 6.1, 6.2, 6.3, 6.5, and 1.6.2(1)(b); and (3) the application fee. When you salmtit your application, be sure
to include o~ (1) cotttplete s28ned end notarized IVORY ORIGINAL and ane (1) copy of the cornpkted Ivy application form, two (2)
copies of Extubite A-J, Exhibit L, Addendum 1, and appropriau sections of 6.5 (Geoteclmical Stability Exhibit), as required, and a check
for the application fee described under (4) below. Exhibits should NOT be bound ox in a 3-ritlg binder; maps ehouldbe folded to 8 1/2" X
11" or 81/2" X 14" size. To expedite processing, please provide the information in the format and order described in this form
OI?NERAL OPERATION INFORMATION
Type or print clearly, in the space provided, ALI. information described below.
1. AnpllcanHolterator or comoanv name (Dame to be used en Dermitl:
1.1 Type oforga,E;~"*:,Yn(~tporation,partnership,etc.): Privar.e T.and Owner
1.2 LRS. Tax ID No. or Social Security Number: S ~ 4 S N t ~ 7 ~
2. Operation name (oit, mine or site name): rrFp~r-Ax>-im a s 5 a nd Ancl ~ ra<>e 1 Pi t
3. Permitted atxesfre (new ore atlnn sitel: _5_,_q_ peraritted acres
3.1 Change in acreage (+)
acres
3.2 Total Acreage in Permit Area 5 _ a acres
4. ~'ggg:
4.1 New Application: $1.094.00 application fee
ATM~+d*TMTrt Fee (C.R.S. 34-32.5-125(II)): 00 application fee
4.2 Conversion Fee (from l IOd to 110 5.0 conversion fee (Rule 1.11.2(2))
5. Prlmarv epmmodiiefsl to be n>ined: ,~_ 1
5.1 Incidental commoditie(s) to be mined: 1. / lbsffony[yd 2, / lbs/TunaJyr 3. / Ibs/Tons/vr
4. / 1baVI'4~~ 5. / lbslTon?/rn~
5.2 Aroiaipated end nee of prip~aty commodite(~ to beLr(tined: Road ma t e r i a i , septic 1 e a ch fie 1 d
Concrete, rip; rap, a ore ive rocc
Anifeipated end nse of incidental commodide(s) to be mined:
__ -_
OfOce of Offire of Cobrado
Mined Land liec)amation Active and Inaceve Mines ne,.i.,,.i~~i s..-.~,