PERMFILE127141

• Permit No: M2002053
• IBM Index Class Name: Permit File
• Doc Date: 10/7/2002
• Doc Name: Exhibit G Source of Legal Right to Enter
• From: John R. Kurtzer
• To: DMG
• Section_Exhibit Name: Permit
• Media Type: D
• Archive: No

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STATE OF COLORr'~DO
DIVISION OF MINERALS AND GEOLOGY
artment of Natural Re
urces
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7373 Sherman SL, Room 215 ~ U ~~'
Denver Cobrado 80203
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FAX: [phone]
CONSTRUCTION MATERIAL PF''iILLIPS CO UNTY CL~ C;i
LIMTTED IRIPACT (110) OPERAT ION
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Df VI SfON O
MINERAL
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GEOLOG
aECLAnAnc
MINING•SAFEr
BiII D`+-ens
RECLAMATION PERMIT APPLICATION FORM Governor
CreR F. Walther
Executive Director
Michael 8. Long
v nn Director
CHECK ONE: _ XR New Application (Rule 1.4) Conversion Application (Rule . r t'~
Amendment Application (C.R.S. 34-32.5-i 10)
Permit # M -` _ _ (provide for Amendments and Conversions of existing permits)
The application for a Construction Materials Limited Impact (110) Operation Reclamation Permit contains three major parts: (1) dte applicauon for:
(2) Exhibits A-J. Exltibi[ L, Addendum 1, any sections of Exhibit 6.5 and Geotechnical StabilityExhibit. as required by the Office, and outlined in Ru:
6.1, 6.2, 6.3, 6.5, and 1.6.2(1)(b); and (3) the application fee. When you submit your application, be sure to include one (1) complete siened a
notarized IVORY ORIGINAL and one (1) copy of the completed I~ application form, two (2) copies of Exhibits A-J, Exhibit L, Addendum 1, a
appropria[8 sections of 6.S {Geotechttical StabilityExhibit), as required, and a check for the application fee described under (4) below. Exhibits sho.
NOT be bound ar in a 3-ring binder; maps should be folded [0 8 ]2" X 11 " ar 8 1 /2" X 14" size. To expedite processing, please provide the informae
in the format and order described in this form.
GENERAL OPERATION INFORMATION
Type or print clearly, in the space provided, ALL information described below.
1. Aoalicant/operatororcomoanvname(nametobeusedonoenttitl: John R. (Dick) Kurtzer
L1 Type of organization (corporation, partnership, etc.): Individual
1.2 I.R.S. Tax ID No. or Sociat Security Number:
2. Operationname(oit.mineorsitename): Kurtzer Gravel Pit
3. Permitted acreaee (nea• or existine sitel; ptoC+~'l /~®
Q7G~r Y 9. 9 permitted ac:
3.] Change inaereage(+) -- acres
Total Acreage in Permit Area ~Ct ~ ~ ~ 9.9 acres
4. Fees: Division of Minerals end Geology
4,1 New Application: 51.094.00 application tee
Amendment Fee (C.R.S. 34.32.5-125(II)): 5719.00 application
4.2 Conversion Fee (from 110d to 120 S875.00 conversion fee (Rule 1.11 <(2p
5. Primary commoditie(sl to be mined: Gravel Sand
S.1 Inciden[al commoditie(s) to be mined: 1. / ibs/Tons/vr 2 / lbs(Tons/vr 3. / Ibs/I'ons
4. / lbslTons/vr 5. / lbslrons/vr
5:_' Anticipated end use of primary commoditie(s) to be mined: Concrete mix, road base
S3 Anticipated end use of incidental commoditie(s) to be trained: