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- <br />ZRTF CAF <br />~ ~ 7S-J <br />rOLORA~O <br />DIVISION OF n71NERALS AND GEOLOGY <br />~i.'U•,.'NICnI irl nd1UL1! (;c~uurcre <br />I J 14 She. ratan SL. Fuom 715 <br />Dzm er. Culo~adu 811'_11] <br />Phnnc iJU 4186fi.15i,? <br />r,;~: nu 1, aJ ~ a nlr~ <br />RECEIVED <br />MAR 0 g 2p00 <br />~hsion of Minerahs ~, °~b9Y <br />CONSTRUCTION MATERIALS <br />RECEIVED <br />FEB 07 2000 <br />Oivislon of Mlnerab & Geology <br />DIVISION O F <br />MINERALS <br />GEOLOGY <br />RECLAMATION <br />MI NING~SAFEiY <br />LIMITED IMPACT (110) OPERATION <br />611 Owem <br />Gurernur <br />RECLAMATION PERMIT APPLICATION FORM Grc•s E. watcher <br />E.ecmive D~reaur <br />Michael B. Lons <br />D~~~sion Dueaor <br />CHECI:ONE: X New Application (Rule 1.4) Conversion Application (Rule 1.11) <br />Amendment Application (C.R.S. 34.32.5-I 10) <br />Permit # M ~OQ~ D-~ (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: (I) the application form; <br />(2) Exhibits A-1, Exhibit L, Addendum 1, any sections of Exhibit 6.5 and Geo[echnical 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)(6); and (3) the application fee. When you submit your application, be sure to include one (I) complete sieved and <br />notarized iV ORY ORIGINAL and one (I) copy of the completed Ivor application form, two (2) copies of Exhibits A-1, Exhibit L, Addendum 1, and <br />appropriate section of F 5 (Geotechnical Stability Exhibit), as required, and a check for the application fee described under (4) below. ~ xi~iuits should <br />NOT be bound ~r in a . rule binder, maps should hr, fc!dea m 8 ! n^ x 11 ^ or 8 l2" X 14" ei~e To expedite prxessing please pwvide the infonna:iun <br />m the format and oruc: describes in this form. <br />GENERAL OPERATION INFORMATION <br />or print clearly, in the space provided, ALL information described <br />Cheyenne County ~`J <br />ApplicanLopentor or comoanv name (name to be used on permit): Rnarrl of Chayonna f nttnr~r ('nmmi sai nn rc <br />1.1 Type of organization (corporation, partnership, etc.): County Government <br />1.2 I.R.S. Tax ID No. or Social Security Number: <br />"_'. Operation name (pit. mine or site namel: hhrnsch Pi t <br />3. Permitted acreage (new or existine sitel: 9.5 permitted acres <br />3.1 Change in acreage (+) acres <br />Total Acreage in Permit Area 9. 5 acres <br />4. Fees <br />4.1 New Application: 875.00 application fee <br />Amendment Fee(C.R.S.34-32.5-125(ilp: $575D0 application fee <br />4.2 Conversion Fee (from I I Od to 110 875.00 conversion fee (Rule 1.11.2(2)) <br />5. Primary commoditie(s) to he mined: Sand Gravel <br />5.1 Incidental commoditie(s) to be mined: 1. / IbsrTonslvr 2. __ / Ib~ITons/vr 3. / Ibc'ions/yr <br />4. / Ibs/fons/vr 5. / Ibs~fonsrvr <br />:.'_ Anticipated end use of primary commoditie(s) to be mined: Sand & Gravel <br />j.3 Anticipated end use of incidental commoditie(s) to be mined: <br />to be spread on County Roads <br />