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Ul t~'10~ <br />DIVISION OF MINERALS AND GEOLOGM <br />Uepanmem ni Natural Resuurces <br />I ] 1 3 Sherman SI., Room ? 15 <br />Denver, Colorado 80203 <br />Phone: 13UJ7 866-3561 <br />FA\:1303) 8J?-8106 <br />~~ ~h Cbrlf s glloor~ <br /> <br />~I , o4~f • o0 <br />OF ~OLORA~O <br />82-1' S cG;. - .:_F .:.n.l r 'a.. t:.2- 115 <br />FOR 17FhOSi' ,1. <br />3U;~~:.~..r. i:... ~ \ .. ;~ttSUhER <br />DEPC-:ivr,~ ACC-iJ <br />DIVI $ION OF <br />MINERALS <br />GEOLOGY <br />RECIA MATION <br />M ININ G•sAFETY <br />LIMITED IMPACT(I10)OPERATION DiviSiOnofMinerdlSiGlObQy ~IVono^~ <br />JUL ~ 0 20~ <br />CONSTRUCTION MATERIALS <br />Greg E. Walther <br />RECLAMATION PERMIT APPLICATION FORM E.eculne Director <br />M¢hael 9. long <br />Division Dnector <br />CHECK ONE: / New Application (Rule 1.4) Conversion Application (Rule 1.11) <br />Amendment Application (C.R.S. 34-32.S-I 10) <br />Permit p M Z°'Q o90-_ (provide for Amendments and Conversions of existing permits) <br />The application for a Construction Materials Limited Impact (110) Operation Reclamation Permit contains three major parLS: (1) the application form; <br />(2) Exhibits A-J, Exlubh L, Addendum 1, any sections of Exhibit 6.5 and Geotechnical Stability Exhibit, as required by the Office, and outlined in Rules <br />6.1, 6.2, 6.3, 6.5, and 1.6.2(1)(b); and (3) the application fee. When you submit your application, be sure to include one (I) complete sieved and <br />notarized IVORY ORIGINAL and one (1) copy o(the completed Ivy application form, two (2) copies of Exhibits A-J, Exhibit L, Addendum 1, and <br />appropriate sections of 65 (Geotechnical Stability Exhibit), as required, and a check for the application fee described under (4) below. Exhibits should <br />NOT be bound or in a 3-ring binder, maps should be folded to 8 12" X ] 1" or 8 1/2" X 14" size. To expedite processing, please provide the information <br />in the format and order described in this form. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, ALL information described below. <br />1. Apulicant/ooerotor or comoanv name (name to be used on permit): LotAVwNEA) gK~S. S ToAJE <br />1.] Type of organization (corporation, partnership, etc.): S CoR PDP.q T10 Al <br />1.2 1.R.5. Tax ID No. or Socia! Security Number: O 71'I 'i52 - 000 <br />2. Operation name foil. mine or site namel: Ly t<In1S GuI~.H <br />3. Permitted acreage (new or existine sitel: G •Q permitted acres <br />3.1 Change in acreage (+) acres <br />Total Acreage in Permit Area 9 .9 acres <br />4. Fees: <br />4.1 New Application: 875.00 application fee <br />Amendment Fee (C.R.S. 34-32.5-125(11)): 575.00 application fee <br />4? Conversion Fee (from 110d to 110 875.00 conversion fee (Rule 1.11.2(2)) <br />5. Primary commoditie/s)to be mined: SAaoSTOA)4 DoE.AlY1mC <br />5.1 Incidental commoditie(s) lobe mined: 1. ~DOO/ ~or1S Ibs/fons/vr 2. 500 /rorJ Ibs/fons/vr 3. / Ibs/fons/vr <br />4. / Ibs/fons/vr 5. / Ibsffons/vr <br />5.2 Anticipated end use o(primary commoditie(s) to be mined: f;r.r~ol N` + l n r~D sc,s JF_ <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: Bono fsKE <br />