PERMFILE104405

• Permit No: M1999073
• IBM Index Class Name: Permit File
• Doc Date: 9/14/1999
• Doc Name: Receipt of Application
• From: DMG
• To: EVAN L MELBY INC
• Media Type: D
• Archive: No

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DIVISION OF MINERALS AND GEOLOGIY
Dcpanmrnl rn Nannal Resources
171 }Sherman SL. Room 215
Denver, Colorado BU2U7
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CONSTRUCTION MATERIALS
9(i
V~ LIMITED IMPACT(110)OPERATION
DIVISION O F
MINERALS
6t
GEOLOGY
RECLAMATION
MINING•$AFET7
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',;~I:;p;;i;;?1d;te~.>:SnLi°D!Og'f RECLAMATION PERMIT APPLICATION FORM ereFE.wakher
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M¢hael B. long
Dnivon Drteaor
CHECK ONE: ~ New Application (Rule 1.4) Conversion Application (Rule I.1 l )
Amendment Application (C.R.S. 34-32.5-I10)
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Permit p M ~,~-_ l~ ~ (provide for Amemdments and Conversioms of existing permits)
The appliraton for a Construaiott Materials Limited lmpact (110) Operarion Reclamation Permit contains three major pare: (I) the application form;
(2) Exhibits A-J, Exhibit L, Addendtan 1, atry sections ofExhtbo 65 and Geotechnical Stability Exhibit, az requved by the Office, end outlined in Rules
6.1, 6.2, 6.3, 6.5, and 1.6.2(1)(b); and (3) the application fce. When you submit your application, be sure to include one (1) comolete simted and
notarized IVORY ORIGQVAL and one (1) copy ofthe completed Ivory application form, two (2) copies of Exhibits A-J, Exhibit L, Addendum 1, and
appropriate sections of 6S (Geotechnical Stability ExhibiQ, az required, and a check for the application fee described under (4) below. Exhibits should
NOT be bound or of a 3-ring bode, maps should be folded m 8 l2" X 11" or 8 12" X 14" size. To expedite processing, please provide the information
in the format and order descnbed in this form. ~ , ~ ,.. „ .
INFORMA
Type or print elnrly, im the space provided, ALL information described below.
1. Applinntlooentor or eomoanv name fmame to be used om mermit): EVAN L. MELBY . INC.
l .l Type of organization (corporation, partnership, etc.): CORPORATION
l.2 I.R.S. Taz [D No. or Social Security Number:
2. Ooeration name foit mine or she namel:
3. Permitted acrnge (new or existime steel: permitted acres
3.1 Change in acreage (+) 12 acres
Total Acreage in Permit Area ~_ acres
4. Fees:
4.1 New Application: 875.00 application fee
Amendmem Fee (C.R.S. 34-32.5-125(11)): SS 75.00 application fee
4:L Conversion Fee (from 1 I Od to I I O 875.00 conversion fee (Rule 1.11.2(2))
5. Primary commoditidsl to be mined: SAND
5.1 Incidental commaditiNs) to be mined: I. / Ibs/fons/vr 2. / Ibslfons/vr 3. / Ibs/fons/vr
4. / Ibslfons/vr 5. / Ibs~fons/vr
5.2 Anticipated end use ofprimary commoditie(s) to be mined: 2005
5.3 Anticipated end use of incidental commoditie(s)to be mined: