PERMFILE128144

• Permit No: M2001085
• IBM Index Class Name: Permit File
• Doc Date: 8/13/2001
• Doc Name: CONSTRUCTION MATERIALS REGULAR 112 OPERATION RECLAMATION PERMIT APPLICATION FORM
• Media Type: D
• Archive: No

TATE OF COLORADO
DIVISION OF MINERALS AND GEOLOGY
Department of Natural Resources
1313 Sherman SI., Room 21 i
Denver, Colorado 130203
Phone: [phone] CONSTRUCTION MATERIALS ~iD
FAX: [phone] REGULAR (112) OPERATION RECEN
RECLAMATION PERMIT APPLICATION FORK( uG 1 3 x,001
DivisiAon of Minerals and Geo1o9V
CHECK ONE: There is a File Number Already Aaaigned to thin Operation
Permit # M ~- (JpJ(-_ (please reference the file ntrmber cutreptly assigned to this operation)
_1('~ New Appicatioa (Rule 1.45)
Conversion Application (Rule I.1 l )
Permit # M -_ -_ (provide for Amendments and Conversions of existing pem»ts)
L~
DIVISION O.`
MINERALS
GEOLOGY"
RECLAMATION
~MINING•SAF ETY
sill Owens
Governor
Greg E. Walther
Executive Director
Michael B. Long
Division Dneuor
The application for a Conshvction Materials Regular 112 Operation Reclamation Permit contains three major parts: (1) the application form;
(2) Exhtbits A-S, Addendum 1, any sections of Exhibit 6.5 (Geotechnical Stability Exhibit; and (3) the application fee. When you submit your
applicadoq be swe to include one (1) complete sued and notarized IVORY ORIGINAL and four (4) copies of the completed [vorv
application form, five (5) copies of Exhibits A-S, Addendum 1, appropriate sections of 6.5 (Geotechnical Stability Exhibit, and a check for
the application fee described under Section (4) below. Exhibits should NOT be botmd or is a 3-ring binder, maps should be folded to
8 1/2" X 11" or 8 1/2" X 14" size. To expedite processing, please provide the information in the format and order described in this form.
GENERAL OPERATION INFORMATION
Type or print clearly, in the apace provided, all information described below.
L A~pGcantloperator or company name (name to be used o0 permit]:
Adams County RV Park, LLC, dba 124th Estates Partners
1.1 Type of organization (corporation, partnership, etc.):

Amendment Application (Rule 1.10)
limited liability company
1.2 LR.S. Tax LD. No. or Social Security Number: (Rave Sch, 1 re~ann )
2.
Operation name (nit. mine or airs name):
124th Estates Sand and Gravel Mine
3.
Permitted acrearre (new or eiiatin¢ aka):
3.1 Change in acreage (+)
3.2 Total acreage in Permit area
4.
Fees
14 - 3 permitted acres
acres
74 - "3 acres
4.1 New Application
4.2 New Quarto Application
4.4 Amendment Fee
4.5 Conversion to 112 operation (se[ by statute)
~.
$2.344.00 application fee
$2.906.00 quarty application
51.938.00 amendment fee
$2.344.00 conversion fee
Primary rnmmoditie(a] to be mined: nand and gravel
S.l Incidental commoditie(s) to be mined: 1. / Ibslfons/yr 2. / Ibs/foos/vr 3. / Ibs/ioos/vr
4. / Ibs/fous/vr 5. / lbs/I'ons/vr
7.2 Anticipated end ass of primary commoditie(s) [o be mined. construction a~grega to
5.3 Anticipated end use of incidental commoditie(s) to be mined: none anticipated