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<br />STATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />Deparlmeni of Natural Resources <br />1313 Sherman Sr., Room 215 <br />Denver, Colorado 80203 <br />Phone: (703) 866-3567 CONSTRUCTION MATERIALS <br />FAX: 1303) 832-8106 REGULAR (112) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />~~ <br />DIVISION O~ <br />MINERALS <br />GEOLOGY <br />RECLAMATION <br />~M INING•$AFETY <br />CHECK ONE: _~ There is a File Number Already Assigned to thia OperaHoo <br />Permit # M - ~ nr*L_-~9 (Please reference We fde attmber currently assigned to this operation) <br />New Application (R.ule 1.4.5) <br />Conversion Application (Rule 1. I I ) <br />~ Amendment Application (Rule I.10) <br />Permit # M -_ (provide for Amendments and Conveniona of existing permits) <br />8JI Owens <br />Governor <br />Greg E Watcher <br />E+ecuuve D~reaor <br />Michael B. Long <br />D~~ision Director <br />The application for a Conswction Materials Regular 112 Operation Reclamation Permit contains three major parts: (I) the application form; <br />(2) Exhrbits A-S, Addendum I, any sections of Exhibit 6.5 (Geotechnical Stability Exhibit; and (3) the application fee. When you submit your <br />application, be sure to include one (1) complete si®ed and notarized IVORY ORIGINAL and four (4) copies of the completed IYON <br />application form. five (5) copies of Exhibits A-S, Addendum 1, appropriate sections of 6.5 (Geotechnical Stability Exhtbit, 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 1 /2" X 11 " or 8 I /2" X l4" size. To expedite processing, please provide the ivforma[ioa in the format and order described in this form. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the apace provided, all information described below. <br />ApoGcant/ooerator or comoaor name (name to be used on oermkl: <br />1.1 Type of organization (corporation, partnership, etc.): <br />iZ LR.S. Tax LD. No. or Social SecuriD' Number <br />2 <br />3 <br />Operation name (nit, mine or sHe name): RENT (:OIINTY PIT ll2 <br />Permitted acreage (new or e:istine site): 17 .87 permitted acres <br />3.1 Change in acreage (+) <br />3.2 Total acreage in Permit area <br />4. <br />Fees <br />4.1 New Application <br />4.2 New Quarry Application <br />4.4 Ameodment Fee <br />4.5 Conversion to 1 12 operation (set by statute) <br />5. <br />Primary commoditie(s) to be mined: Gravel <br />(,L acres <br />18.51 acres <br />$2.344.00 application fee <br />$2,906.00 quarry application <br />$1.938.00 amendment fee <br />$2.344.00 conversion fee <br />5 1 Incidental commoditie(s) to be mined: I. / Ibs/Cons/vr 2. ! IbsffonsNr 3. / Ibsffons/vr <br />4. / lbs(ToashT 5. / Ibsfl'ons/vr <br />5.2 Anticipated end use of primary commoditie(s) to be mined. <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: <br />