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Ill 1111111111111111 99 STATE Off' COLOM DO <br /> DIVISION OF MINERALS AND GEOLOGY <br /> Department of Natural Resources S <br /> 1313 Sherman St., Room 275 MAR 3 11999 <br /> e Colorado 8U207 <br /> Phone: <br /> Phanc:(3031864-3567 �• �, <br /> l.l(111832.81 Uh gr{)YA(`{CE o"ICT WR 15 1999 <br /> DEPARTN1EIv7 OF � <br /> CONSTRUCTION MATERIALS �& a F,U. NATURAL <br /> OURCES <br /> LIMITED II4pACT (110) OPERATION <br /> go,Romer <br /> RECLAMATION PERMIT APPLICATION FORM Co,emor <br /> James S.Lochhead <br /> becwwe Director <br /> Michael S.Long <br /> CHECK ONE: New Application (Rule 1.4) Conversion Application (Rule 1.11) DiOsion 0"ector <br /> _ Amendment Application (C.R.S. 34-32.5-110) <br /> Permit # - (provide for Amendments and Conversions of <br /> existing permits) <br /> The application for a Construction Materials Limited Impact (110) Operation Reclamation Permit <br /> contains three major parts: (1) the application form; (2) Exhibits A-J, Exhibit L, Addendum 1, <br /> any sections of Exhibit 6.5 'and Geotechnical Stability Exhibit, as required by the Office, and <br /> Dutlined in Rules 6.1, 6.2, 6.3, 6.5, and 1.6.2(1) (b) ; and (3) the application fee. When you <br /> submit your application, be sure to include one (1) complete sicned and notarized IVORY ORIGINAL <br /> and one (1) copy of the completed Ivory application form, two (2) copies of Exhibits A-J, <br /> Exhibit L, Addendum 1, and appropriate sections of 6.5 (Geotechnical Stability Exhibit) , as <br /> -equired, and a check for the application fee described under (4) below. Exhibits should NOT be <br /> )ound or in a 3-ring binder; maps should be folded to 8 1/2" X 11" or S. 1/2" X 14" size. To <br /> axpedite processi provide the information in the format and order described in this <br /> :orm. <br /> GENERAL OPERATION INFORMATION <br /> Type or print clearly, in the space provided, ALL information described below. <br /> Applicant/operator or company name (name to be used on Permit) : <br /> ��a-EMatist G,-e.ny V-xw%R--V bF �eMM1SSsO.J E.fc�j <br /> 1.1 Type of organization (corporation, partnership, etc. ) : Gov-T k•Ec-*,6-i <br /> 1.2 I.R.S. Tax ID No. or Social Security Number: <br /> Operation name (pit, mine or site name) . <br /> Permitted acreage (new or existing site) : permitted acres <br /> 3.1 Change in acreage (+) acres <br /> Total Acreage in Permit Area acres <br /> Fees: <br /> 4 .1 New Application $875.00 application fee <br /> Amendment Fee (C.R.S. 34-32.5-125 (II) ) $575.00 application fee <br /> 4.2 Conversion Fee (from 110d to 110 $815.00 conversion fee (Rule 1.11.2 (2) ) <br /> Primary commoditie(s) to be mined: �OAD V�ATL5 -V-AVEL- <br /> 5. 1 Incidental commoditie s) to be mined: 1. 301 0 0©- +} !�/Tors/vr <br /> 2. / lbs/Tons/vr 3. / lbs/Tons/vr <br /> 4 . / lbs/Tons/vr 5. I lbs/Tons/vr <br /> 5.2 Anticipated end use of primary commoditie(s) to be mined: ?c bD Mantis <br /> 5.3 Anticipated end use of incidental commodities) to be mined: ^�f <br />