PERMFILE124716

• Permit No: M2002053
• IBM Index Class Name: Permit File
• Doc Date: 6/26/2002
• Doc Name: Application Form
• From: John R. Kurtzer
• To: DMG
• Section_Exhibit Name: Permit
• Media Type: D
• Archive: No

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STATE OF CO~,~J~IZ~DO
DIVIS30N OF MINERALS AND GEOL ~///,~.
Department of Natural Resources ~®~ ~f /~ w~~®II6p ~~~~7 ~ s
1313 Sherman SL, Room 215 J`H a.~® DIVISION o F!
Denver, Colorado 80203
Phone: [phone] ,~U~
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FAX: [phone] C ~ ?U©? ~~
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LIM TED IMPACT 1 0) OPERATION of/;rrreja/s anti Leo/ogy
MINERALS!
GEOLOGY
RECLAMATION
MIN ING•SAFETY
Bill Owens
RECLAMATION PERMIT APPLICATION FORM Governor
Greg E. Watcher
Executive Director
Michael B. Long
CHECK ONE: XX New Application (Rule 1.4) Conversion Application (Rule ~YVS'}°O Dtre~t«
Amendment Application (C.R.S. 34-32.5-110)
Permit # M -d 0t7 =~J 3. (provide for Amendments and Conversions of existing permits)
The application for a Construction Materials Limited Impact (110) Operation Reclamation Permit contains three major pazts: (1) the application form;
(2) Exhibits A-J, Exhibit L, Addendum I, any sections of Exhibit 6.5 and Geo[echnical Stabili[yExhibit, as required by the Oftice, and outlined in Rules
6.1, 6.2, 6.3, 6.5, and 1.6.2(1)(b); and (3) [he application fee. When you submit your application, be sure [o include one (1) complete siened and
notazized IVORY ORIGINAL and one (1) copy of the completed Ivory application form, two (2) copies of Exhibits A-J, Exhibit L, Addendum 1, and
appropriate sections of 6.5 (Geotechttical 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; [naps should be folded to 8 12" X I 1 " or 8 1/2" X 14" size. To expedite processing, please provide the information
in the format and order described in [his form.
GENERAL OPERATION INFORMATION
12.
13.
Type or print clearly, in the space provided, ALL information described below.
A~rQticantloperatoror comoanv name (name to be used on oermitl: John R. (Dick) Kurtzer
1.1 Type of organization (corporation, partnership, etc.):
Individual
1.2 LR.S. Tax ID No. or Social Security Number:
Oueration name (oit, mine or site name): Kurtzer Gravel Pit
Permitted acrea¢e (new or existine site);
3.1 Change in acreage (+)
Total Acreage in Permit Area
~ 4.
~ 5.
Fees:
4.1 New Application:
Amendment Fee (C.R.S. 34-32.5-125(II)):
4.2 Conversion Fee (from I lOd to 110 8$ 75.00 conversion fee (Rule 1.11.2(2))
Primary commoditie(s) to be mined: Gravel Sand
9.9 permitted acres
-- acres
9.9 acres
$1.094 00 application fee
719.00 application fee
5.1 Incidental commoditie(s) to be mined: 1. / lbs/fons/vr 2. / Ibs/Tons/vr 3. / ibs/fons/vr
4. / Ibsrl'ons/vr 5. / 1bsfI'ons/vr
5.2 Anticipated end use of primazy commoditie(s) to be mined:
Concrete mix, road base

5.3 Anticipated end use of incidental commoditie(s) [o be mined: