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STATE OF COLORADO <br />DIVISION OF RECLAMATION, MINING AND SAFETY <br />Department of Natural Rewurces / rr~~ p p-~ <br />' <br />~ <br />p~°,'p""~ <br />1313 Shemwn St., Room 215 <br />D <br />d <br />2 <br />3 ~_ / <br />)Oh~ _ /~J/~ <br />~-^ <br />(J <br />d C O L O R A A O <br />o 80 <br />0 <br />enver, Colora <br />Phone:1303) 666-3567 T <br />V <br />JUN 2 7 ZQp~ n I V 15 I O N O f <br />RECLAMATION <br />FAX: (303) 832$106 MINING <br /> Division of Reclamation, - &- <br /> Mining and Safety SAFETY <br /> CONSTRUCTtONMATERIALS <br /> LIMTTED IMPACT (110) OPERATION a'e o"'e15 <br /> Governor <br /> RECLAMATION PERMIT APPLICATION FORM Russell George <br /> Executive Director <br /> Ronald W. CatUny <br />CHECK ONE: There is a File Namber Already Assigned to this Operation Division Director <br /> Natural Resounx Trustee <br />Pemilt # M -_ ~ _ (Please reference the file number currently assigned to this operation) <br />X New Application (Rule 1.4.5) Amendment Application (Rule 1.10) <br /> Conversion Application (Rule Li l) <br />Petmit # M -J , (provide for Amendments and Cooversioos of existing pernits) <br />The application for a Construction Materials Limited Impact (110) Operation Reclamation Pemrrit 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 <br />by the Office, and outlined in Rules b.l, 6.2, b.3, 6.5, and 1.b.2(1)(b); and (3) the application fee. When you submit yourapplication, be <br />sure to include one (1) corr~lete sivted and notarized ORIGINAL, and one (1) copy ofthe completed 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 <br />the application fee described under (4) below. Exhibits should NOT be bound or in a 3-ring biller; maps should be folded to 8 1 /2" X <br />11" or 8 112" X 14" size. 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, in the space provided, ALL information described below. <br />t. Aoolicant/ocerator or company name (name to be used on cermitl: H/S Properties <br />1.1 Type of organization (corporation, partnership, etc.): Partnership <br />2. Ooeration name (nit. mine or site natcel: H/S Properties Gravel Pit <br />3. Per mitted acrea¢e (new or existint sitel: 5.005 permitted acres <br />3.1 Change in acreage (+) acres <br />3.2 Total Acreage in Pemtit Area acres <br />4. Fees: <br />4. t New Application: 1094.00 application fee <br /> Amendment Fee (C.R.S. 34-32.5-125(II)): 5719.00 application Cee <br />4.2 Conversion Fee (from I IOd to 110 875.00 conversion fee (Rule 1.11 .2(2)) <br />5. Primary trommoditie(s) to be mined: Sand Gravel <br />5. t I~idental comtrwditie(s} to he mined: t. / lbs(fous/vr 2. / Ihstfons/vr 3. J ihsrfons(vr <br /> <br /> 4. / lbs/Tons/vr 5. / IbsTfons/vr <br />5.2 Anticipated end use of primary conmloditie(s) to be mined: Construction aggregate <br />Anticipated end use of incidental commoditie(s) to be mined: <br />Office of Office of <br />