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E~mlr- 1`1 h r5 <br />,M~~od$_b~~ <br />STATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />Department of Natural Resources <br />1323 Sherman St., Room 215 <br />Denver, Colorado 60203 <br />Phone: (303) 866.3567 <br />FAX: (303) 832-8206 <br />CONSTRUCTION MATERIALS <br />LIMITED IMPACT(110)OPERATION ~~~~'~~sQ <br />RECLAMATION PERMIT APPLICATION FORM AUG 1 ~ Z005 <br />COLORADO <br />DIVISION O F <br />MIN SRALS <br />GEOLOGY <br />0.ECLA MATIDN•MINING <br />SAFETY•SCIENCE <br />Bill Owens <br />Division ai Minerals & Geology Governor <br />Greg E. Walther <br />CHECK ONE: There is a File Number Already Aasigaed to this Operation Executive Director <br />Permit # M -_ ` _ (Please reference the file number currently assigned to this operation) Rnnald w. CananY <br />Division DireROr <br />X New Application (Rtile 1.4.5) Ameadmept Application (Rtile 1.10) Natural Resource Trustee <br />Coaveeaion Application (Bute 1.11) <br />Permit # M -_ -; (providefor Amendments and Conversions of existing permils) <br />The applicationforaConstructionMaterialsLimitedlmpact(110)OperationReclamationPermitcotttainstiueemajorparts: (1)theapplication <br />form; (2) Exhibits A-J, Exhibit L, Addendtmm 1, any sections of Exhibit 6.5 and Geoteehnical Stability Exhibit, as required by the Office, and <br />outlined in Rules 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 <br />(I) comolete simed and notarized IVORY ORIGINAL and one (1) wpy of the completed Ivor, application form, two (2) copies of Exhibits <br />A-J, Exhibit L, Addendtmm 1, and appropriate sections of 6.5 (Geotechnica] Stability Exhibit), as required, and a check for the application fee <br />described under (4) below. Exhibits should N2 be bound or in a 3-ring binder; maps should be folded to 8 1/2" X 11" or 8 1/2" X 14" size. <br />To expedite processing, please provide the information in the format and order described in this form. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, is the apace provided, ALL information described below. <br />I . ApplicaaUocerator or rnmpanv name (name to be used on cetmR3: Wa 1 d ('nnn r v P„h l ; r Wn rk c <br />i.l Type of organization (corporation, partr,etship, etc.): government <br />1.2 1.2 I.R.S. Tax ID No. or Social Sextnity Number: <br />2. Operation Dame (nit. mine or site Hamel: Ashbaugh Gravel Pit <br />3. Permitted acreage (pew or e:istoE¢ site: 9.9 permitted acres <br />3.1 Change in acreage (+) acres <br />3.2 Total Acreage in Permit Area acres <br />4. Fees: <br />4.1 New Application: $I 094.00 application fee <br />Amendmen[Fee (C.R.S. 34-32.5-125(II)): $719.00 application fee <br />4.2 Conversion Fee (from I lOd to 110 $875.00 conversion fee (12u1e 1.11.2(2)) <br />5. Primary commoditie(s) to be mined: :;ravel dirt <br />5. ] Incidental commoditie(s) to be mined: 1. / ]bs/Tonslvr 2. / lbs/Tons/vr 3. / ]bs/I'ons/vr <br />4. / Ibs/Tons/vr 5. / lbs/fons/tr <br />5.2 Anticipated end use of primary commoditie(s)tobemined: County road maintenance and Ironctn rtion <br />Anticipated end use of incidental commoditie(s) to be mined: <br />Offic„ of Office of Colorado <br />Mined Land Reclamation Active and Inactive Mines 2005-2417 Geological Survey <br /> <br />