PERMFILE105762

• Permit No: M2001108
• IBM Index Class Name: Permit File
• Doc Date: 11/9/2001
• Doc Name: Permit Application
• From: Alamosa County
• To: DMG
• Section_Exhibit Name: Permit Doc
• Media Type: D
• Archive: No

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ST~T~ OF CQLC~I~DO
DIVISION OF MINERALS AND GEOLOGY
Department of Natural Resouues
l3 t 3 Sherman St., Room 215 R~^ ~E~ 1{ ED
Denver, Colorado 80203 ~}, O t v i~ t O u O
Phone: (303) Bb6-3567 Qv ~~// nn nn ~~~1 M[ N E R A C
FAX: iJ031 83 2-81 06 \ ., rj~y 1~ 7 &.
q~ _ ~~~ CONSTRUCTION MATERIALS G E O L O G'
I` ` tstan of Mlnarals and Geolo Ya E c t. n n n r ~ o r
LIibiITED IMPACT (11Q) OPERATIC '"~NtNC •sArEr~
` RECI:ANIATJON PERYIIT APPLICATION FORM Bill Owens
Governor
Geq E. welcher
Eaecurive Dtrec~or
Michael B. long
IECK ONE: There is a File Number Already Assigned to this Operation Divlslon oire<<or
Permit # M -aZ(01-~_-_ (Please reference the file number currently assigned to this operation)
New Application (Rule ].4.5) _ Amendment Application (Rule ).1D)
_ Conversion Application (Rule 1.11)
Permit # M -_ (provide for Amendments and Conversions of existing permits)
~.e application for a Construction Materials Limited Impact (I 10) Operation Reclamation Permit contains three major parts: (t) the
plication form; (2) Exhibits A-J, Exhibit L, Addendum 1, any sections of Exhibit 6.5 and Geotechnical Stability Exhibit, as required by
:Office, and outlined in Rules 6.1, 6.2, 6.3, 6.5, and 1.6.2(1)(6); and (3) the application fee. When you submit your application, be sure
include one (1) complete si¢ned and notarized IVORY ORIGINAL and one (1) copy of the completed Ivy application form, two (2)
pies of Exhibits A-J, Exhibit L, Addendum 1, and appropriate sections of 6,5 (Geotechnical Stability Exhibit), as required, and a check
the application fee described under (4) below. Exhibits should NOT be bound or in a 3-ring binder; maps should be folded to 8 1J2"
1" or 8 112". X 14" size. To expedite processing, please provide the information in the format and order described in this form.
INFORMA'I'lON
Type or print clearly, in the space provided, ALL information described below...
ApplicanUoperator or company name (name to be used on permit):
1.7 Type of organization (corporation, partnership, etc.): COUl~I7 y ~ oVE~Nrn~~T
1.2 [.R.S. Tax ID No. or Social Security Number: 2.;
At~rvrt©s.9 cv~t,Jfy t~,'7- Na. 2
10. O permitted acres
Change in acreage (+) - acres
Total Acreage in Permit Area [~• 0__ acres
New Application: 1 094.D0 application fee
Amendment Fee (C.R.S. 34.32.5-125(II)): $719.00 application fee
Conversion Fee (from ] l Od to 110 8$ 75.00 conversion fee (Rule 1.11.2(2))
ary commodities) to be mined: G~i¢UEL sAN7
Incidental commoditie(s) to be mined: 1. / Ibs/Tons/yr 2. ! Ibs/i'onsfvr 3. / Ibsll'onslyr
4. / lbsll'onsJvr 5. / 1bslionslyr
Anticipated end use of primary commoditie(s) to be mined: f'il~ JI1/1TE,C~'A~I lSO4C'1 p1~sL /)5/°/~ALr1~Q~h
Ipated end use of incidental commoditie(s) to be mined: N/f}