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~ ~dao~/- oa3 / <br />STATE, OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />Department of Natural Resources <br />1313 Sherman St., Room 215 <br />Denver, Colorado 80203 D I v 15 1 D N o f <br />Phone: (303) 866-3567 ~ n'1 I ~ E RA 1. $ <br />FAX: 1303) 832-s106 CONSTRIICTION 1FL>S.TEI~L4LS _ 6: <br />/LIllIITED IlIIPACT (110) OPERATION R~C'~r ~~1~ GEE O n O o N <br />MINING•SA FE7Y <br />RECLAMATION PER1vIIT APPLICATION FOR~QR Z B 2004 <br />Bill Owens <br />91r1$iaa a( Governor <br />- Minerals and Geology Greg E. Walther <br />CHECK ONE: There is a Fr3e Number Already Assigned to this Operation ExecWve Director <br />Ronald W. Cottony <br />Permit tt 1vI -Z°~~- O Z~Please reference the file number cturentty assigned to this operation) Aeling Division Director <br />X New Application (Rule I.4.5) <br />Amendme~ Application (Rule 1.10) <br />Conversion Application (Rule 1.11) <br />Permit ~ M_- _ (provide for Amendments and Conversions of existing permits) <br />The application for a Construction Materials Limited Impact (110) Operation Reclamation Permit contains three major parts: (1) the <br />application form; (2) Exhibits A-J, Exhibit I., Addendum i, any sections ofExllibit 6.5 and Geotechnical Stability Exhibit, as required by the <br />Office, and outlined in Mules 6.1, 62, 6.3, 6.5, and 1.62(1)(6); and (3} the application fee. When you submit your applicafion, be sure to <br />include one (1) complete signed and notarized IVORY ORIGINAL and one (1) copy of the completed No application form, two (2) copies <br />of Exhibits A-J, Exhibit L, Addendum 1, and appropriate sections of 6.5 (Geotec]mical Stability Exhibit), as required, and a check for the <br />a_n~n1;~~_atinn feg dec.-:h>rt under j4)below. F~hth:+~ ~~ .~•t?dl.~T be bonndor sn-a 3-r..np birder; maps should be#'alded to R iJ2" X 11 " ar <br />8 1/2" X 14" size. To expedite processing, please provide the information in the format and order described in this form. <br />GI~IERAI, OPERATION INFORMATION <br />Type or print clearly intbe apace provided, ALL i~'ormation described below: <br />1. Aonlicant/oaerator or comianvname (name to be used on Hermit): Ph; ] 1 ; ps County '~ <br />1.1 Type of organization (corporation, partnership, etc.): County Government <br />1.2 I.RS. Tax ID No. or Social'SecnrityNumber: 2.: <br />2. Oierationname(nit.mineorsitename): Havnes Hereford Ranch Pit <br />3. Permitted acrease (new or existine site): 9.9 permitted acres <br />3.1 Change in aoteage (k) sores <br />3.2 Total Acreage in Permit Area 9.9 acres <br />4. Fees: <br />4.1 New Application: 094A0 application fee <br />Amendment Fee(C.RS.34-32.5-125(IT)): $719.00 application fee <br />4.2 Conversion Fee (from I lOd to 110 875.00 conversion fee (Rule 1.1 i.2(2)) <br />5. Primary commoditie(s) to be mined: Gravel Sand . <br />5.1 Incidental commoditie(s) to be mined: 1. / lbs/fon_ys! r 2. / Ibs/Ton s/~ 3. / lbs/T~ <br />4. // lbs/T'ons/vr 5. / IbslTon~ <br />5.2 Anticipated end use of primary commoditie(s)tobemined: Road buildingand maintenance <br />Anticipated end use of incidental commoditie(s) To be mined: <br />