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STATE OF COLORADO <br />DIVISION OF RECLAMATION, MINING AND SAFETY <br />Deparmem of Natural Resources ~~ <br />1313 Sherman St., Room 215 <br />C O L O R A D O <br />Denver, Colorado 80203 DIVISION O F <br />Phone: (303) a663567 CONSTRUCTION b1ATFRIALS RECLAMATION <br />rnx: ao3) a3zatoe REGULAR (112) OPERATION M [ N I NG <br /> - &- <br /> RF,CI,ADIATION PERMIT APPLICATION FORM SAFETY <br />size Owens <br />Governor <br />CHECK ONE.:: There is a Flle Nundrer Already Assigned to this Operation Rosseu eeorge <br />Pemut # M - zoa7-O1 ~ (Please reference the file number currently assignad to this opera~SFt)11e Dtretmr <br />Ronald W. Cattany <br />~_ New Application (Rule 1.4.5) - - _ Amendment Application (Rule I. l0) Division po-~mr <br />_ Conversion Application (Rule 1.11) Narurel Resource Truafee <br />Permit # _ti~,-` _ (provide for Amendments and Conversions of existing permits) <br />The application for a Construction Materials Regular 1 l2 Operntion Reclamation Permit contains three major parts: (1) the application <br />form; (2) Exhibits A-S, Addendum 1, any sections of Exhibit 6.5 (Geotechnical Stability Exhibit; and (3) the application fee. When you <br />submit your application, be sure to include one (1) complete sieved and notarized ORIGINAL and one(() rgpy of the completed <br />application form, two (2) copies ofExhibits A-S, Addendum 1, appropriate sections of6.5 (Geotechnical Stability Exhibit, and a checkfor <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 tit" X 11" of 8 I/2" X 14" size. 'I'o expedite processing, please provide the information in the format and order described N this form. <br /> GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, ALL information requested below. <br />I. Auolicantlopcrator or comoanv nnrne (name to be used on oermit): __ GregOL '~L~LS.QIl_,_ ~____~._ <br /> 1.1 Type of organization (corporation, partnership, etc.): Individual <br />2. Operation name (pit. mine or site name): t arson pi r <br />3. Permitted acreage tnew or existine site): 68.0 permitted acres <br /> 3.1 (.grange in acreage (+) 0 _ acres <br /> 3.2 'Dotal acreage in Permit area (R p acres <br />4. Fees: - - - ~~y <br /> 4.1 New Application 5136.dY~StC application fee <br /> 4.2 Yew Quarry Application 2 906.00 yuarry application <br /> 4.4 Amendment Eye _938.00 amendment fee <br /> 4.5 Conversion [0 112 operation (set by statute) $2344.00 conversion fee <br />5. Primary commoditie(s) [o be mined: Gravel .$_~trd___ C~~r -...__. .._ <br /> 5.1 Incidental commoditie(s) to be mined: I. ,___,._____.________lbsiTons;k 2. / _ 16vTDns/vr <br /> 3. .._^__ i ___, IbsiTonsiyr 4. _.__ / IbsrTonshT 5. ___ Ibs/']'ons/y+r <br /> 5.2 Anticipated end use of primary commoditie(s)tobenrined: Cnnarrnr•rtnn mater{al 1.-,--~ <br /> S.3 Anticipated end use of incidental conmloditie(s) to be mined: _____,_„_,______..___ ,~__ _.,__,________~ ..._..~ <br /> Office of Office of <br />Mined land Reclamation _ Active and Inactive Mines <br />