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Vi- ~o~ 5-O~la <br />CONSTRUCTION MATERIALS <br />REGULAR (112) OPERATION <br />RECLAMATION PERMTT APPLICATION FORM <br />RECEIVED <br />ocr ~ 3 Zoos <br />Division at Minerals and 6et{Ody <br />CHECK ONE Thoe~r~e~,is/a File Number Already Assigned to this Operation <br />Permit # _iv~-dUf~ ~-_ (please reference the file number currently assigned to this operation) <br />X New Application (Rule ] 4 5) _ Amendment Application (Rule 1.10) <br />_ Conversion Application (Rule 1 11) <br />Permit # M -_ _ _ (provrde far Amendments and Conversions of existing permits) <br />The application for a Construction Materials Regular 112 Operation Reclamation Perron contains three major parts (1) the application <br />form, (2) Exhtbds A-S, Addendum 1, any sections of Exhrbtt 6.5 (Geotechnrcal StabiliTy Exhibit, and (3) the apphcanon fee. When you <br />suborn yow application, be sure to include one (]) g~lete sia-tied and notarized ORIGINAL and one Q) copy of the completed <br />application form, two (2) copies of Exhibits A-S, Addendum 1, appropriate sections of 6.5 (Geotechnical Stability Exhibit, andacheck for <br />the application tee described under Section (4) below Exhibits should g be bound or in a 3-ring binder, maps should be folded to <br />8 I/2" X 1 I" or 8 I R" X 14" size. To expedite processing, please provrde the tnformatron rn the format and order described rn this form <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, fn the space provided, @.LL intormation requested below. <br />I Annlicant/ouera[or or comoanv name !name to be used on oermiti: Asphalt Paving Company <br />I 1 Type of organization (corporation, partnership, acJ: Corporation <br />1 2 1 R.S Tax ! D No or Social Security Number' <br />2. ooeraHon name Inst, mine or site Hamel: Wattenberg West Sand and Gravel Mine <br />3 Permitted acreage (new or exlsttne sltel <br />3 l Change m acreage (+) <br />3 2 Total acreage m Permit azea <br />135 +/- permitted saes <br />acres <br />135 +/- acres <br />4 Fegg <br />4 I New Application 52.344 00 application fee <br />4 2 New Quarry Application 52.906.00 quarry application <br />4 4 Amendment Fee X1.938.00 amendment fee <br />4 5 Conversion tc 112 operation (set by stature) 52,344 00 conversion fee <br />5 gyi marv cammoditie(sl [o he mined; Sand gravel <br />5 1 Incidental commodi[te(s) to be mined: 1 None - Ibs/Tons/vr 2 / Ibs?ons/vr <br /> 3 / Ibsll'ons/vr 4 / IbslTons/vr 5. / Ibs/Tons/vr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: COrISYR1CYlOn Aggregate <br />5 3 Antretpated end use of incidental commoditie(s) to be mined. None <br />