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<br />DIVISION OF MINERALS AND GEOLOGY <br />Drpariment of Natural Resources <br />111 4 Sherman Sr., Ruum ? I i <br />Denver, Colorado NU2UJ <br />Phune. (3US1 abG-J.Sh7 <br />FAX: (1031 alt-al(lti <br />`IIIIIIIIIIIIIIIIIII ~~ ~~g~5 <br />999 ~~ a o ~ 3 <br />STATE OF COLORADO <br />CONSTRUCTION MATERIALS <br />REGULAR (112) OPERATION <br />Q <br />Qlv o <br />~~~ <br />O <br />RECLAMATION PERMIT APPLICATION FORM <br />oc <br />S~ <br />~~ <br />DIVISION O F <br />MINERALS <br />GEOLOGY <br />RECLA RATION <br />MINING•SAFETY <br />B~II Owens <br />Guvemoi <br />Greg E. Walther <br />Execmme Director <br />CHECK ONE: ~ New A lication Rule 1.4.5 Amendment A lication Rule 1.10rrr chael B. Lonl; <br />PP ( ) PP ( Division Dhectnr <br />Conversipo'~n A~pp~lication (Rule 1.11) <br />Permit # A~• ~~ lJ`--~-~ (provide for Amendments and Conversions of existing permits) <br />The application for a Construction Materials Regular 112 Operation Reclamation Permit contains three major pare: (I) the application forth; <br />(2) Exhibits A-S, Addendum 1, arty sections ofExhibit 6.5 (Geotechnical Stability Exhibit; and (3) the application fee. When you submit your <br />application, be sure to include one (1) complete signed and notarized IVORY ORIGINAL and four (4) copies of the completed Ivy <br />application forth, five (S) copies of Exhibits A-S, Addendum 1, appropriate sections of 6.5 (Geotechnical Stability Exhibit, and a check for <br />the application fee described under Section (4) below. Exhibits should NOT be bound or in a 3-ring binder; maps should be folded to <br />8 I/2" X t I" or 8 I/2" 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, io the space provided, ALL information requested below. <br />I. Aoolicant/ooerator or comosnv name [Dame to be used on permitl: <br />1.1 Type of organization(corporation,parmership,etc.~Offat County Road Department <br />1:2 I.R.S. Tax I.D. No. or Social Securiry Number: 8~-6000-785 <br />2. Ooerationoame(pit.mineorsitenamel: Villard Pit #2 <br />3. Permitted acrea¢e toew or existitr¢ sitel: 66 permitted acres <br />3.l Change in acreage (+) acres <br />3.2 Total acreage in Permit area 66 acres - <br />4. Fees <br />4.1 New Application XXXX 51.875.00 application fee <br />4.2 New Quarry Application 52.325.00 quarry application <br />4.3 Milling Application (Non-DMO} 53.[00.00 milling application <br />4.4 Amendment Fee 51.550.00 amendment fee <br />4.5 Conversion to 112 operation (set by statute) 51.875.00 conversion fee <br />5. Primary commoditie(sl to be mined: Sand Gravel Rock <br /> N~A <br />5.1 Incidental commoditie(s) to be mined: 1. Ibs/Tons/vr 2 / Ibs(fons/vr <br /> 3. / Ibs/I'ons/vr 4. ! Ibs(Tons/vr 5. / Ibslfons/vr <br />5.2 Anticipated end use ofprimary commoditie(s) to be mined: Road Cons truCtionand D'lainterianee <br /> NSA <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: <br />