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STATE OF ~OLOI~DO <br />DIVISION OF RECLAMATION, MINING AND SAFETY <br />Department of Yatural Resources <br />1373 Sherman SL, Room 215 <br />Denver, Colorado 80203 COLORADO 'i <br />OI VISION OF. <br />Phone: (303} 86fr3567 CONS1'RUG"CION ~IA'I'ERIALS RECLAMATION <br />FAX: (303} 832106 REGULAR (112) OPERATION M [ N t NG <br />-&- <br />RF.CLAMATION PERMIT APPLICATION FORM SAFETY <br />aal Uvnns <br />Governor <br />CHECK ONF.: There is a Filc Number Already Assigned to [his Operation Rv,sQu eE»rae <br />Permit # M - 2oa7-Ol ~ (Please referencr the file number cttrrently assigned to this opera~SN~"'B onr<ror <br />Ronald W. Cattany <br />~_ New Application (Rule 1.4,5) _ Amendment Application (Rule 1.10) Oivf:Ion oire~ior <br />Conversion Applicaton (Rule 1.1 l) Natural Resource Trustee <br />Permit # ~f _ (provide for Amendments and Conversions of existing permits) <br />The application for a Constmc[ion Materials ReyFdar 1 l2 Operation Reclamation Permit contains three major parts: (1) the application <br />form; (2) Exhibits A-S, Addendtun 1, any sections of F,xhibit 6.5 (Geotechuical Stability Exhibit; and (3) the application fee. When you <br />submit your application, be sure to include one (1) comolete sigtted and noiariud ORIGINAL and one (1) copy of the completed <br />application form, iwo (2) copies ofExhibits A-S, Addendum 1, appropriate sections of6.5 (Geotechnical Stability Exhibit, and a check for <br />the application fee described under Section (4) below. Exhibits should N01' be bound or in a 3-ring binder; maps should be folded to <br />8 i i2" X 11" or 8 U2" X 14"size. 'Co expedite processing, please provide the information in the format and order described in this form <br />GENERAL OPERATION <br />Type or print clearly, in the space provided, Al.l, information requested below. <br />L AualicanUoocrator or comoanv name (name to be used on oermitl:.,-Ss~gs-r.~.L~~.Lt ______ <br />1.1 Type of organization (corporation, partnership, etc.): <br />2. Operation name (oit, mine or site name): <br />3. Permitted acreaee Inew or ezistlne site): <br />3.1 Change in acreage (~) <br />3.2 "total acreage in Permit area <br />4. E'ees: -- - <br />4.1 New Application <br />4.2 New Quarry Application <br />4.4 Amendment Fei <br />4.5 Conversion to 112 operation (se[ by statute) <br />5. Primary rnmmoditie(si [o be mined: Gravel ~~~,___ .~J~y,~__,_ <br />5.1 Incidental commoditie(s) to be mined: L .___._____________Ibs!Tons/,~ <br />3. __-- ~ ------ Ibs?off 4. -- ~ Ibsr'1'onsfvT <br />68.0 permitted acres <br />0 ~ acres <br />6g n acres <br />y36.2~:SLC application fee <br />2 906.00 quarry application <br />_~1~938.00 amendment fee <br />_~ 344 00 conversion fee <br />2. ~_/ ______ IbsiTons/vr <br />5. __ / Ibsll'onsiyr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: er3~ __~__.__ <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: ________________________._,_____._~___,_, _ <br />C)fflCf! Of ~ffiCe Of <br />Mims) Land Rcalamatiun A<tive and Inactive Mines <br />