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j~l~-2~~ ~~ <br />STATE OF COLO~~~~ <br />DIVISION OF MINERALS AND GEOLOGY C/'~ `, t'~ <br />Department of Natural Resources RGV~~ V ELA <br />1313 Sherman 6t., Room 215 <br />Denver, Colorado 80203 FEB 2 8 2003 Mt I NSE RA L S <br />Phone: (303) 866-3567 <br />FAX: (303) 832-8106 <br />Division of Minerala end Geology G E O L O G Y <br />FILE COP <br />A/; ,¢J jj~~'A, RECLAMATION <br />CONSTRUCTIONMATEI3IAIS f {\~Lld~aitl+ ,Y MINING•SAFETY <br />REGULAR (112) OPERATION <br />Bill Owens <br />RECLAMATION PERMIT APPLICATION FORM Governor <br />Greg E. watcher <br />Executive Director <br />CHECK ONE: There is a Fr7e Number Already Assigned to this Operation Ronald w. cottony <br />Pemtit # M --_ _ (Please reference the file number currently assigned to this operation) Acting Division Director <br />X New Application (Rule 1.4.5) _ Amendment Application (Rule 1.10) <br />Conversion Appbcation (Rule 1.1 I) <br />Permit # M -- -J (provide for Amendments and Convenioas of existing permiU) <br />The application for a Construction Materials Regular 112 Operation Reclamation Pemrit contains three major parts: (1) the application form; <br />(2) Exhibits A-S, Addendum 1, a~ sections of Exhibit 6.5 (Geoteclmical Stability Exhibit; and (3) the application foe. When you submit your <br />application, be sloe to include one (1) co~lete siffied and notarized IVORY ORIGINAL and one (1) copy of the completed I~ application <br />form, two (2) copies of Exhibits A-S, Addendum 1, appropriate sections of 6.5 (Geotechnical Stability Exhibit, and a check far the application <br />fee descnbed Hider Section (4) below. ]xhibits should NOT be bound or in a 3-ring 1»nder; maps should be folded to 812" X 11" or 8 1/2" <br />X 14" size. To expedite processing, please provide the information vt the format arrd order descnbed in this form. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, hn the space provided, ALL information requested below. <br />1. <br />Apulhcantlocerator or company name (name to be used on uermitl: SW Meadow, LLC <br />1.1 Type of organization (corporation, partnership, etc.): Limited liability company <br />12 I.RS. Tax I.D. No. or Social Security Number: <br />2. <br />3. <br />Operation name (pit, mine or site Hamel: Heit Sand and Gravel Mine <br />Permitted acreage (new or eSlathlo site): <br />3.7 Change in acreage (+) <br />3.2 Toia' acrea~z v1 Perait arza <br />4. Fees: <br />4.1 New Application <br />4.2 New Qoarry Application <br />4.4 Amendment Fee <br />4.~ Conversion to 112 operation (set by statute) <br />~. Prhmarv commoditie(sl to be mined: sand gravel <br />5.1 Incidental commoditie(s) to be mined: 1. - Ibs/Ionslvr <br />102 permined acres <br />D acres <br />102 <br />acres <br />$2.344.00 application fee <br />52.906.00 gpazry application <br />51.938.00 amendment fee <br />$2.314.00 conversion fee <br />2. / lbs/fons/yr <br />3. ! Ibs/TonsJvr 4. / lbs/Tonslvr 5. ! 1bsrTonsFr. <br />5.2 Anticipated endlueofprimarywmmoditie(s)[obemined: construction aggregate <br />5.3 Anticipated endaseofincidentalcommodiRe(s)tobeminednone anticipated. <br />