PERMFILE134131

• Permit No: M2000028
• IBM Index Class Name: Permit File
• Doc Date: 3/2/2000
• From: GREG LEWICKI AND ASSOCIATES
• To: DMG
• Media Type: D
• Archive: No

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STATE OF COLORADO
DIVISION OF MINERALS AND GEOLOGY
Depanmenl of Natural Resources
1313 Sherman Sr., Room 215
Denver, Colorado 80203 .-, ,^ !~~ t- ~ ~ ~ (~
Phone: [phone] `v'
FA%: !3031 83 2-81 06
CONSTRIICTION MATERIALS
LIMITED IMPACT OPHRATION (110)x`°''""' `'''~"~LLis ~ ue010gy
RECLAMATION PERMIT APPLICATION FORM
CHECK ONE: New Application (Rule 1.4)
DEPARTMENT' OF
NATURAL
RESOURCES
Roy Romer
Governor
lames S. Lxhhead
E><ecueve Director
Michael g. Long
Division Director
Ameadment Application (C.R.S. 34-32.5-110)
Conversion Application (Rule 1.11)
Permit # ~~~ -~Z~ -_ (provide for Ameadmeats and Conversions of
existing permits)
The application for a Construction Materials Limited Impact Mining (110) Operation Reclamation
Permit contains three major parts: (1) the application form; (2) Exhibits A-J and Exhibit L,
Addendum 1, any sections of Exhibit 6.5 and Geotechnical Stability Exhibit, as required by the
Office, and outlined in Rules 6.1, 6.2, 6.3, and 6.5; and (3) the application fee. When you
submit your application, be sure t0 include One (1) Complete signed and notarized IVORY ORIGINAL
and one (1) copy of the completed ivory application form, two (2) copies of Exhibits A-J and
Exhibit L, appropriate sections of 6.5 (Geotechnical 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; maps should be folded to 8 1/2" X 11" or 6 1/2" X 19" size. To expedite processing,
please provide the information in the format and order described in this form.
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GENERAL OPERATION INFORMATION
Type or print clearly, in the space provided, all information described below.
______________________________________________________________________________________________
1. Applicant/operator or-CgmDanv name (name to be used on permit):
1.1 Type of organization (corporation, partnership, etc.): U /V _
1.2 2.R.S. Tax ID No. or Social Security NCumber. ~ /~i,~~~/y -Q~~CD- TAT
2. Operation name (pit, mine or site name): ~L~ ~1~ ~/l lJ ( ` I
22 /' i
3. Permitted acreage (new or existing site): ~~•,l ,~1. ~ F S permitted acres
3.1 Change in acreage (+ or -) acres
Total Acreage in Permit Area acres
4. Fees:
4.1 New Application 5675.00 application fee
Amendment Fee (C.R.S. 34-32.5-125 (II)) 5575.00 application fee
4.2 Conversion Fee (from 110d to 110 5875.00 conversion fee (Rule 1.11.2(2))
S. Primary commoditie(s) to be mined: SRA~ ~ ~FV~
5.1 Incidental commoditie(s) to be mined: 1. lbs/Tons/vr
2. / lbs/Tons/vr 3. / lbs/Tons/vr
4. / lbs/Tons/vr 5. / lbs/Tons/vr
5.2 Anticipated end use of primary commoditie(s) to be mined: RbAfl BASE
5.3 Anticipated end use of incidental commoditie(s) to be mined: