PERMFILE118141

• Permit No: M2007076
• IBM Index Class Name: Permit File
• Doc Date: 10/15/2007
• Doc Name: Application form
• From: Cheyenne County
• To: DRMS
• Media Type: D
• Archive: No

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STATE OF COLORADO
DIVISION OF RECLAMATION, MINING AND SAFETY
Depattment of Natural Resources RECEIVED ~~
7313 Sherman st., Room 275 C O L O R A D O
Denver, Colorado 80203
Phone: [phone]
OCT 15 2007 D I v 1 5 1 0 ti O F
RECLAMATION
FAX: t303I B32Et06 / MINING
Division of Reclamation
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CONSTRUCTION MATERIALS
Bill Ritter, Ir.
LIMITED IMPACT (I10) OPERATION Goverlnr
RECLAMATION PERMIT APPLICATION FORM Hams D. Sherman
Eu2uLve Dinxypr
Ronald W. Canany
Division Director
CHECK ONE: There fs a File Number Already Assigned to this Operation Natural Resource rmstee
Pemtit # _ M --~~ (~2(p Please reference the file number cutrentty assigned to this operation)
~_ New Application (Rule 1.4.5) ___ Amendment Application (Rule L 10)
Conversion Application (Rule 1. l 1)
Permit # M -`__ ____ ~ (provide for Amendments and Conversions of existing permits)
The application for a Constmction Materials Limited Impact (110}Operation Reclamation Perr77it contains three major parts: (I) We
application fomr; (2) Exhibits A-J, Exhibit L, Addendum 1, any sections of Exhibit 6.5 and Geotechnicat Stability Exhibit, as required
by the Office, and outlined in Rules 6.1, 6.2, 6.3, 6.5, and 1.6.2(l)(b); and (3) the application fee. When you submit your application, be
sure to include one (1) corrmle[e signed and notarized ORIGINAL and one (1) copy of the completed application form, two (2) copies
of Exhibits A-J, Exhibit L, Addendum I, and appropriate sections of 6.5 (Geotechnicat Stability Exhibit), as required, and a check for
the application fee described under (4) below. Exhibits should NOT be bound or in a 3-ring binder; maps should be folded to 8 112" X
1 l" or 8 l12" X 14" size. To expedite processing, please provide the information in the format and order described in dos form
GF;NERAf. OPERATION INFORMATION
'Type or pdn[ clearly, in the space provided, ALL information described below.
L Aoolicant/ooeralor or comoanv name (name to be used on oermitl: Cheyenne County /
LI "fypeoforganization(cotporatio»,partnership,etcJ: County Government ~`_
2. Oueration name foih mine or site name): K 1 emen t P i t
3. Permitted acreage (new or existine site): ~ • 2 4 permitted acres
3.1 Change in acreage (+) _ acres
3.2 Total Acreage in Permit Area _. ~,.24` acres
4. Fees:
4.1 New Application: 1 258.00 application tee
Arnendmcnt Fee (C.R.S. 34-32.5-125(II)): 8s z7.00 application fee
4.2 Conversion Fee (fkom 1 IOd to 110 1 2 . 0 conversion fee (Rule 1.1 i.2(„2)}
5. Primarvcomntoditie(sltobernined: Sarid Gravel ~__
S.l Incidental commoditie(s) to be reined: t. Ibs/Tons/vr 2. ! lbs~fonslvr 3. / Ibsi fons'~r
4. / lbsi l'or_usiyr
5.2 Anticipated end use of primary commoditie(s) to he mined:
Anticipated end use of incidental commoditie(s) to be nvr7ed:
5. Ibs~fons/yr
Sand & gravel to spread on cnty rds
N/A
(Nfice of office of
Mined Larxl ftxaamauon Denver • Grand Junction Durango Active and Inactive, Mines