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/.5~ ,5u6.nft~~ <br />STATE OF COLORADO <br /> <br />DIVISION OF MINERALS AND GEOLOGY ~ ~i/'/JyJQ ~~~ ~ ~~/ <br />Department of Naturel Resources " (j/~f <br />1373 Sherman St., Room 215 <br />Denver, Colorado 80203 CONSTRUCTION111ATERIALS RECEIVED <br />Phone: (303) 866-3567 <br />FAX: (303) 832-x706 REGULAR (112) OPERATION MAY 21 2004 <br />RECLAMATION PERMIT APPLICATION FORM <br />Division of Minerals & Geology <br />CHECK ONE: There is a File Dlumber Already Assigned to this Operation <br />Pe[mit # M -Z o PL- b37 (Please reference the file number currently assigned to this operation) <br />XX New Application (Rule 1.4.5) _ Amendment Application (Rule I.10) <br />Conversion Application (Rule 1.11) <br />Permit # M -_ -~ (provide for Amendments and Conversions of existing permits) <br />COLORADO <br />D I V I S I O N O E <br />MIN SRALS <br />GEOLOGY <br />0.E CLAM ATIDN•NINING <br />EAf ETT•SCIENCE <br />Bill Owens <br />Governor <br />Greg E. Walther <br />Executive Director <br />Ronald W. Cattany <br />Division Director <br />Na[u21 Resource Trustee <br />The application for a Construction Materials Regulaz ] 12 Operation Reclamation Permit contains three major parts: (1) [he application form; <br />(2) Exhibits A-S, Addendum 1, atry sections of Exhibit 65 (Geotechnical Stability Exhibit; and (3) the application fee. When you submityour <br />application, be sure to include one (1) complete sieved and notarized IV ORY ORIGINAL and one (1) copy ofthe completed No application <br />form, two (2) copies ofExhibits A-S, Addendum 1, appropriate sections of 6.5 (Geotechnical Stability Exhibit, and a check for the application <br />fee described under Section (4) below. Exhibits should NOS be bound m in a 3-ring binder, maps should be folded to 8112" X ] ] "or 8111" X <br />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 apace provided, ALL information requested below. <br />1. Aoplicant/ocerator or ^omoaov name (name to be used on cermitl: John M. Everitt // <br />1.1 Type of organization (corporation, partnership, etc.): T n d i v; do a 1 <br />1.2 I.R.S. Tax I.D. No. or Social Security Number: <br />2. Onerationname(nit.miceorsitename): Everitt Pit i/ <br />3. Permitted acreage (new or eaistint site): <br />3.1 Change n7 acreage (+) <br />32 Total acreage in Permit area <br />4. Fees: <br />4.1 New Application <br />4.2 New Quarry Application <br />4.4 Amendment Fee <br />4.5 Conversion to 112 operation (set by statute) <br />9.9 permitted acres <br /> acres <br />9.9 acres <br /> <br />$2.344.00 application Fee <br />$2.906.00 quarry application <br />$1.938.00 amendment fee <br />$2.344.00 conversion fee <br />5. Primary commoditie(al to be mined: Gravel <br />5.1 Incidental commoditie(s) to 4e mined: I . Ibslfons/vr <br />3. ! Ibs(foos/vr 4. / lbs/Tons/vr <br />2. / Ibs/fonshT <br />5. / IbslCons/vr <br />5.2 Anticipated end use of primary commoditie(s)tobemined: Aggregate for concrete <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: <br />Office of C~ce of Coorado <br />Mined Land Reclamation Active and Inactive Mines Geological Sun <br />