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STATE OF COLOKAD0 <br /> ON DIVISI MINERALS AND GEOLOGY RECEIVE p <br /> Department of of Natural Resources <br /> 1313 Sherman St.. Room 215 Denver,Colorado 80203 NOV 2 2 100IVI5I0N O F <br /> o0 Phone:I308 2-810 CONSTRUCTION 67 CONSION MATERIAI,� & <br /> MINERALS <br /> FAX:(303) 32-8106 Er1S100 0( <br /> LIMITED MIPACT(110)OPERATION M1finerals and Geology a E C LA M GEOLOGY o N <br /> MINING-SAFETY <br /> RECLAMATION PERMIT APPLICATION FORM <br /> Bill Owens <br /> Governor <br /> Greg E.walcher <br /> CHECK ONE: There is a File Number Already Assigned to this Operation Execmne Director <br /> 2000-092 <br /> Permit# M - _ (Please reference the file number currently assigned to this operation) michael B.Long <br /> Divi:ion Director <br /> X New Application(Rule 1.4.5) _Amendment 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 L,Addendum 1,any sections of Exhibit 6.5 and Geotechnical Stability Exhibit,as required by the <br /> Office,and outlined in Rules 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 <br /> include one(1)complete si®ed and notarized IVORY ORIGIN i and one(1)copy of the completed Ivory application form,two(2)copies <br /> of Exhibits A-J,Exhibit L,Addendum 1,and appropriate sections of 6.5(Geotechnical Stability Exhibit),as required, and a check for the <br /> application fee described under(4)below. Exhibits should NOT be bound or in a 3-ring binder,maps should be folded to 8 1/2"X I I"or <br /> 8 12"X 14"size. To expedite processing,please provide the information in the forma described in this form. <br /> GENERAL OPERATION INFORMATION <br /> Type or print clearly,in the space provided, ALL information described below. <br /> I. AppOcant/oyerator or company name(name to be used on permits: <br /> City of Walsenburg <br /> 1.1 Type of organization(corporation,partnership,etc.): Municipality <br /> 1.2 I.R.S. Tax ID No.or Social Security Number:2.: 84-6000627 <br /> 2. Operation name(pit,mine or site name): Walsenburg Gravel Pit <br /> 3. Permitted acreage(pew or existine site): 9.9 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: dzu0 a lication <br /> Amendment Fee(C.R.S.34-32.5-125(II)): $719.00 application fee <br /> 4.2 Conversion Fee(from 110d to 110$875.00 conversion fee(Rule 1.11.2(2)) <br /> 5. Primary commoditie(s)to be mined: cant) gravel <br /> 5.1 Incidental commoditie(s)to be mined: 1. N/A/ Ibs/fons/vr 2. / Ibs/fons/vr 3. / Ibs/ConshT <br /> 4. / Ibs/fons/vr 5. / Ibs/Ibns/vr <br /> 5.2 Anticipated end use of primary commoditie(s)tobemined: Construction Aggregates <br /> Anticipated end use of incidental commoditie(s)to be mined: N/A <br />