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<br />~ 114 IIIIIIIIIIIII III <br />STATE OF COLORADO <br />DIVf510N OF MINERALS AND GEOLOGI' <br />Department of Ndlural Resources <br />1313 Sherman 51., Room 21 i <br />Denver, Colorado 80'03 <br />Phone: IS031 866-3561 <br />FAx (303) 83?-8106 <br />CONSTRUCTION MATERIALS <br />REGULAR (112) OPERATION <br />RECLAMATION PERh1IT APPLICATION FORM <br />Fees: <br />4.1 New Application ~ <br />4.2 New Quarry Application <br />4.4 Amendment Fee <br />4.5 Conversion to 112 operation (set by statute) <br />~~ <br />D I VISION O <br />MINERAL <br />GEOLOGI <br />RECLAMATION <br />MINING•SAF ETY <br />sin Owens <br />Governor <br />Greg E. bvalcher <br />E.ecuuve D~reaor <br />CHECK ONE: There is a File Number Already Assigned [o this Operaiiun Michael s. Long <br />Dwision U~reclar <br />Permit # Nt -_ _ _ (Please reference the file number currently assigned to this operation) <br />x New Application (Rule 1.4.5) <br />Conversion Application (Rule 1.1 I ) <br />_ Amendment Application (Rule I.10) <br />Permit # M -_ _ _ (provide for Amendments and Conversions of existing permits) <br />The application For a Construction Materials Regular 112 Operation Reclamation Permit contains three major parts: (I) 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 sinned and notarized IVORY ORIGINAL and four (4) copies of the <br />completed Ivory application forth, five (5) copies of Exhibits A-S, Addendum 1, appropriate sections oF6.5 (Geotechnical Stability Exhibit, <br />and a check for the application fee described under Section (4) below. Exhibits should NOT be bound or in a 3-ring binder; maps should <br />be folded to 8 12" X I I" or 8 I/2" X 14" size. To expedite processing, please provide the information in the format and order described <br />in [his form. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, all information described below. <br />Applicanf/operator or company name (name to be used on permit): ~ fillSIC1R CORStSUCtlOn Canpany <br />1.1 Type of organization (corporation, partnership, etc-): COI-[JO]"atioR <br />1.2 ].R.S. Tax I.D. No. or Social Security Number <br />2. <br />3. <br />Operation name (pit, mine or site name): PlnO Pit <br />Permitted acreage (new or existing sitel: <br />3.1 Change in acreage (+) <br />3.2 Total acreage in Permit area <br />4. <br />5 <br />Primary commoditie(s) to be mined: Sand Gravel <br />~i i~ <br />a~ <br />80 permitted acres <br />acres <br />80 acres <br />$2.344.00 application (ee~ <br />0-quarry n~pllca tot n <br />$1.938.00 amendment fee <br />$2.344.00 conversion (ee <br />5.1 Incidental commoditie(s) to be mined. I NA ( Ibsflons/vr 2. / Ibs(fonslyr 3. / Ibslfonslyr <br />4. / Ibs/fons/vr 5. / Ibs/Ions/vr <br />5:2 Anticipated end use of primary commoditie(s) to be mined: Con5tZllCtion aggregates <br />-v~ <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: ~ <br /> <br />