PERMFILE134453

• Permit No: M2000059
• IBM Index Class Name: Permit File
• Doc Name: CONSTRUCTION MATERIALS LIMITED IMPACT 110 OPERATION RECLAMATION PERMIT APPLICATION FORM
• Media Type: D
• Archive: No

.r ,,r ~ III IIIIIIIIIIIIIIII
999 5 iATE OF
COLORADO
• DIVISION OF MINERALS AND GEOLOGY
Depanmem of Natural Resources
1313 Sherman St., Room 2I i
Denver, Colorado 80203
Phone: [phone]
FAti: (303)83?-8106
MATERIALS
LIMITED IMPACT (110) OPERATION
Roy Romer
Governor
RECLAMATION PERMIT APPLICATION FORM lames 5. Lo<hhead
Evecubve Director
M¢hael B. Long
Division Director
CHECK ONE: !/New Application (Rule 1.4) Amendment Application (C.R.S. 34-32.5-110)
Conversion Application (Rule 1.11)
Permit # - -_ (provide for Amendments and Coaversione of
existing permits)
The application for a Construction Materials Limited Impact (1101 Operation Reclamation Permit
contains three major parts: (1) the application form; (2) Exhibits A-J, 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, 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"sioned and notarized IVORY ORIGINAL
and one (1) copy of the completed Ivorv application form, two (2) copies of Exhibits A-J,
Exhibit L, Addendum 1, and appropriate sections of 6.5 (Geotechnical Stability Exhibit), as
aired, and a check for the application fee described under (4) below. Exhibits should NOT be
nd or in a 3-ring binder; maps should be folded to 8 1/2" X il" 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 Driest clearly, is the space Drovided, ALL information described below.
----------------------------------------------------------------------------------------------
1. Applicant/operator or company name (name to be used on permit):
1.1
1.2
i
i
i
i
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t
~i
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i
2. O perat on acme (p
ne or s
te name) :
t, m
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./
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ii t: C
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3.
Permitted acreage (new or existing site): ~
~
`/, r1 9.9 permitted acres
3 .1 Change in acreage (+ or -I acres
Total Acreage in Permit Area acres

4. Feces:
4 .1 New Application 5875.00 application fee
Amendment Fee (C.R.S. 34-32.5-125(II)) 5575.00 application fee
4 .2 Conversion Fee (from 110d to 110 875.00 conversion fee (Rule 1
.11.2(2))
5. Primar y commoditie(s) to be mined: ~` -'"~uG ~ .~' "' //
4'~f ~bli!
• 5 .1 Incidental commoditie(s) to be mined: 1. - lbs/Tons/yr
2. / lbs/Tons/vr 3. / lbs/Tons/yr
4. / lbs/Tons/vr 5. / lbs/Tons/yr
5. 2 Anticipated end use of primary commoditie(s) to be mined: -Tu,;l1¢i;ea~.lY(~~Q(h~~k/.((_,
5. 3 Anticipated end use of incidental commoditie( s) to be mined:
Type of organization (corporation, partnership, etc.): _
I.R.S. Tax ID No. or Social Security Number: