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1 <br />f <br />1 <br />1 <br /> <br /> <br />1 <br />• III IIIIIIIIIIIII III • ~~~5 °~ <br />~T~TE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />Depanmem of Natural hesources <br />131 t Sherman Sr . Ruum ? I5 <br />Denver. Culuradu NU2U3 <br />Phune: 13031 tSbh-35h: <br />FqX: I3UA N3?-H1U6 ~~ <br />\i~ <br />REC€-.~~r~~ <br />~~ <br />hIU~~/ ~ h ~'!• n~ <br />.M ~ ~ CONSTRUCTION MATERIALS Division of Mmcr,,s and Geology <br />`I~~ REGULAR(112)OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />DIVISION O F <br />MINERALS <br />& ! <br />GEOLOGY': <br />RECLAMATION <br />MIN ING•SAf ETY ~ <br />Bill Owens <br />Govemnr <br />Crcg E Walchcr <br />E.ecuu~e Dneaor <br />CHECK ONE: X New A lication Rule 1.4.5) Amendment A lication Rule 1.10 chael0 Long <br />PP ( PP ( ims,on Direcmr <br />Conversion Applicaion (Rule 1.1 i ) <br />Permit k M - Q~ ~ - ~Q7-_ (provide for Amendments and Conversions of existing permits) <br />' The application for a Conswction Mazerials Regular 112 Operation Reclamation Permit contains three major pans: (I) the application form; <br />(2) Extubits A-S, Addendum I, any sections of Exhibit6.5 (Geotechnical Stability Exhibit and (3) the application fee. When you submit your <br />application, be sure to include one (1) 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, appropriate sections of 6.5 (Geotechnical Stability Exhibit, and a check for <br />the application fee described under Section (4) below. Exhibits should NOT be bound or in a 3-ring binder; maps should be folded to <br />8 1J2" X I l" 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 print clearly, in the space provided, ALL informstioH requested below. <br />Northern Colorado Constructors, Inc <br />' I. ApHlicaot/ooerator or eomoaov Dame (Dame to be used on Hermit): <br />I.I Type of organization (corporation,parmership,etc.): Corporation <br />' 1:2 I.R.S. Tax1.D.No.orSocialSecuriryNumber: <br />2. Operation Dame (Hit. mine or site name): NCCI Pit k 1 <br />3. Permitted acreage foew or existioe site): i p ~ ~ ~ permitted acres <br />3.1 Change in acreage (+) -0- acres <br />' 3.2 Total acreage in Permit area 1 0 2 . 6 6 acres <br />4. Fees: <br />' 4.1 New Application $1.875.00 application fee <br />4.2 New Quarry Application 52.325.00 quarry application <br />4.3 Milling Application (Non-DMO) $3.100.00 milling application <br />' 4.4 Amendment Fee $1.550.00 amendment fee <br />4.5 Conversion to 112 operation (set by statute) 51.875.00 conversion fee <br />5. Primary commoditie(s1 to be mieed: Sand Gravel <br />5.1 Incidental commoditie(s) to be mined: I. NA - Ibs/fons/vr 2. NA / Ibs/Tons/vr <br />3. NA / Ibslfons/vr 4. NA / Ibslfons/vr 5. NA / Ibslfons/vr <br />' S.2 Anticipated end use of primary commoditie(s)tobemined: Construction Materials <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: NA <br />1 <br />