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ii iiiiiiiiniii iii • • <br />REC~.~t'.~ED STATE OF COLORADO <br />DIVISION OF MINERALS AN{{D GE GY ±.: tll Q~V2d <br />Department of Natural R~~es~ 3 L~ ,•'" ~ <br />RECE[~ fir... <br />131 ]Sherman SI ,Room ? I5 - <br />Denver, Colorado OO~D3 aoo D I v 15 I O N O F <br />Phone: c3o31 aea-igylstuR of Minerals and Geology ~E~ ~ 1 2 MINERAL S <br />CONSTRU@~'~bN bIATE~LS <br />FAA. (3031 832-8106 REGpULAR (1]2) OPEY~ATION 6c <br />RECLAMATIiIIVikERMITAPPLICATlON FORM p~ran9o Field 08i~e0 rrjGR]tyyc ~ N ~ o ~ <br />.r meralsBG "rrrN ING•SAFET'1 <br />pivision of M <br />Bill Owens <br />Governor <br />CI-IECK ONE: There is a File Number Already Assigned to this Operation Greg E. Watcher <br />Permit # M -_ _ _ (Please reference the fde number currentty assigned to this operation) E>,ecvrwe O~reaor <br />M,chaelB Long <br />X New Application (Rule 1.4.5) _ Amendment Application (Rule 1.10) Division oireclor <br />Conversion Application (Rule 1. ] 1) <br />Permit # M -_ _ - (provide for Amendments and Conversions of existing permits) <br />The application for a Conshvcuon Materials Regular 112 Operation Reclamation Permit wnteins three major parts: (1) the application form; <br />(2) Exhibits A-S, Addendtmt 1, any sections of Exhibit 6.5 (Geotcehnical Stability Exhibit and (3) the application fce. 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 Ivory. <br />application form, live (5) copies of Exhibits A-S, Addendum I, appropriate sections of 6.5 (Geo[echnical Stability Exlribi[, 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 I l" or 8 1/2" X 14" size. To expedite processing, please provide the information in the format and order described in this form. <br />GENERAL OPERATION INFORMATION <br />Type or punt clearly, in the space provided, all information described below. <br />1. Aoolicant/ooerator or comoanv Dame (Dame to be used on oermitl: <br />Mario Bassi and Josephine Bassi <br />1.1 Type of organization (corporation, partnership, etc.): ptoprietrzrs <br />1.2 I.RS. Tax I.D. No. or Social Security Number: <br />2. Ooeratioonamefoit,mineorsitenamel: North Farm Road Gravel Pit <br />3. Permitted aceaee (new or eaistine site): 220 permitted acres <br />3.1 Change in acreage (+) acres <br />3.2 Total acreage in Permit azea 220 acres <br />4. Feea: <br /> <br />.1 New Aoobcation ~ $2 344.00 ,application fee <br />4.2 New Quarry Application $ quarry application <br />4.4 Amendment Fee $1.938.00 amendment fee <br />4.5 Conversion to 1 12 operation (set by statute) 52,344.00 conversion fee <br />5. Prim arvcommodkie(s)tobemined: ~,,,t „ot fill material <br />- ~-ef <br />5.1 Incidental commoditie(s) to be mined: I. N/A/ Ibs/fons/vr 2. / Ibs/I'ooslvr 3. / Ibs/Tons/vr <br /> 4., / lbs/fons/~ 5. / ]bs/fons/vr <br />~.2 Anticipated end use of primary commoditie(s)tobemined: Construction Aggregates, concrete, asphalt <br /> <br />5.3 N/A <br />Anticipated end use of incidental commoditie(s) to be mined: roa ase <br />