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87s1 <br />~~~ ~~~~~~~~~~~~~ ~~~ '~ ~~ . F~ ~ <br />,.. ~.~T.. CJr ~.OLORP>.~~ <br />DIVISION OF MINERALS AND GEOLOGY <br />D.~p.:rlmrnl rn Nawral Reanuces <br />1) I }Sherm.ln 9., Ruam , I S F~ECEIVED <br />Drocer. Culoradu 80'_07 D I v 15 1 0 N O f <br />I''4nnc 1}f1fIL'66-75h7 ~Eg 07 2000 MINERAL $ <br />Fn S: 1.7071 N77~H 1116 <br />GEOLOGY <br />t)IVislon c] Minerdle & Geology R E C L A n A T 1 0 N' <br />MININ G•$AFETY <br />CONSTRUCTION MATERIALS <br />sill owes, <br />LIMITED IMPACT (110) OPERATION en~ernor <br />Greg E. watcher <br />RECLAMATION PERMIT APPLICATION FORM Ftecun.e Dvectur <br />Michael B long <br />0~•ulon D~renor <br />CHECK ONE: X New Application (Rule 1.4) Conversion Application (Rule 1.11) <br />Amendment Application (C.R.S. 34-32.5-I10) <br />Permit b M ~~~ ~~~ (provide for Amendments and Conversions of existing permits) <br />The application Cor a Consttttttion Materials Lnrtited Impact (i 10) Operation Reclamation Permit contains three major parts: (I) the applicazion form; <br />(2) Exhibits A-], ExlubitL, Addendum 1, any sections of Exhibit 65 and Geotechnical Stability Exhibit, as requ'ved by the Office, and outlined is Rules <br />6.1, 6.2, 6.3, 6.5, and 1.61(1)(b); and (3) the application fee. When you submit your application, be sure to include one (I) comolete sitmed and <br />natariud NORY ORIGINAL and one (1) copy ofthe completed vo 'application form, two (2) copies of Exhibits A-1, Exhibit L, Addendum 1, and <br />appropriate sections of R.5 (Geetechnical Stability Exhibit), as required, and a check for the application fee described under (4) below. exhibits should <br />~1pT be bound ^: in a ?-ring border, maps should be ~ !den to 8 1 R' X 11" or R l2" X 14" s'v.?_ To expedite processing, please provide the informaSon <br />in the formaz and oruc: described in this form. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, is the space provided, ALL ioforraatioo described below. <br />1. Aaplicantlooentor or eomoanv name !name to be used oopermitl: nn_~-A of Cho}rar,no Cn„nr3r f:nmmi sai opera <br />1.1 Type of organization (corporation, partnership, etc.): County Government <br />1.2 I.R.S. Tax [D No. or Social Security Number: <br />2. OQeration oa_meipit, mine or site name <br /> <br />3. Permitted acreage (new or existing sitel: 9.5 permitted acres <br />3.1 Change in acreage (+) acres <br />Total Acreage in Permit Area 9.5 acres <br />4. Fees: <br />4.1 New Application: 875.00 application fee <br />Amendment Fee (C.R.S. 34-32.5-125(11)): 575.00 application fee <br />4? Conversion Fee (from I I Od to 110 8$ 75.00 conversion fee (Rule I.I 11(?)) <br />5. Primary commoditie(s) to he mined: Sand GLavel <br />S.l Incidental commoditie(s) to be mined: 1. ! Ibs/Tons.IVr 2. / Ib~lfons/vr 3. / Ibc?ons/vr <br />4. / Ibs~fons/vr 5. / Ibs/fons!yr <br />5.'_ Anticipated end use of primary commoditie(51 to be mined: Sand & GLaVel to be Spread On COltn[y Roads <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: <br />