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<br />^IVISION OF MINERALS AND GEOLOGY <br />Department ni Natural Resources <br /> <br />STATE OF COLORADO <br />13 7.1 Sherman Sc.. Room ? 15 [9 ~ ~ 1~ 9!~ ~ <br />Denver, Colorado N0203 ~E <br />FAX(1U03l1 a132~11 D6 / \O ! RIQI! ~ .~ 'too' <br />`~. <br />~0~ CONSTRUCTION MATERIALS pivision of Minerals and Geology <br />(t~ ~ REGULAR (112) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />~~ <br />DIVISION OF <br />MINERAL <br />GEOLOGI <br />R E C L A M A T I O N <br />MINING•SAFETY <br />all Owens <br />Cavernnr <br />Gres E. Walther <br />Executive Direcmr <br />CHECK ONE: X New A lication Rule 1.4,5) Amendment A Iication (Rule I.10~(.~t1'cnael e. tnn~; <br />PP ( ~ PP bivn~on Director <br />_ Conversion Applicaion (Rule 1. t 1) <br />Permit # M -~- X07 -_ (provide for Amendments and Conversions of existing permits) <br />The application for a Construction Mazerials Regular 112 Operation Reclamation Permit contains three major parts; (I) the application form; <br />(2) Ex}ubits A-S, Addendum 1, any sections ofExhibit 6.5 (Geotechnical Stability Exhibit; and (3) the application fee. When you submit your <br />application, be sure to include one (i) co_[n plete signed and notarized IVORY ORIGWAL and four (4j copies of the completed Ivory <br />application farm, five (5) copies of Exhibits A•S, Addendum I, appropriate sections of 6.5 (Geotechnical Stability Exhibit, and a check for <br />the application fee described under Section (4) below. Exhibits should NOT be bound or in a 3-ring binder; maps should be folded to <br />8 1/2" X 1 I" or 8 1/2" X I4" size. To expediu processing, please provide the information in the format and order described in this form. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, io the space provided, A~It information requested below. <br />Northern Colorado Constructors, Inc <br />1. ApolicaoUooerator or eomoaov Dame (name to be used oopermftl: <br />1.1 Type of organization (corporation, pattnership,eu.): Corporation <br />11 LR.S, Tax I,D. No. or Social Security Number. <br />2. Operatioo Dame fnit- mine or site Hamel: NCCZ Pit # 1 <br />3. Permitted acrease fnew or existiogsitei: t n ~ ~ r; permitted acres <br />3.1 Change in acreage (+} - 0 - acres <br />3.2 Toral acreage in Permit area 1 0 2. 6 6 acres - <br />4. Fees: <br />4.] New Application SL875.00 application fee <br />4.2 New Quarry Application 52.325.00 quarry application <br />4.3 Milling Application (Non-DMO) 53.100.00 milling application <br />4.4 Amendment Fee X1.550.00 amendment fee <br />4.5 Conversion to 1 ! 2 operation (set by statute) 51.875.00 conversion fee <br />5. Primary commaditielsl to be mined: Sand Gravel <br />5.1 lncidental commoditie(s) [o be mined: 1. NA - Ibs/Tons/vr 2. NA / IbslTonslvr <br /> 3. NA / Ibs/Cons/yr 4. NA / Ibsfrons/yr 5. NA I lbs/fonslvr <br />5.2 Anticipaudenduseofprimarycommoditie(s)[obemined: Construction Materials <br />5.3 Anticipated end use of incidental commoditie(s) [o be mined: NA <br />