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~~ <br />STATE OF <br />2 o a'7- o > 2 <br />COLORADO <br />DIVISION OF RECLAMATION, MINING AND SAFETY <br />Department of Natural Rr_sources <br />[373 Sherman St., Room 275 <br />Denver, Calarndo 80203 C O L O R A D O <br />DIVISION O r <br />Phone: (303) 866-3567 CONSTRUCTION MATF,RIALS RECLAMATION <br />FAx: (303) 832~81n6 REGULAR (112) OPERAT!ON M [ N I NG <br />-&- <br />RECLAMATION PEILVIIT APPLICATIOiY FORV1 SAFETY <br />Bill Owens <br />Govemar <br />CHECK ONF_,: There is a File Number Already Assigned to this Operation Russell George <br />Permit # ~ -_ _ _ (Please reference [he file number currently assigned to this opera""` o"""°r <br />Ronald W. Cottony <br />_ New Application (Rule 1.4.5) ~ Amendment Application (Rule 1.10) Division Dimctor <br />Conversion Application (Rule l.I 1) Natural Resource Trustee <br />Permit # ~ -_ -_ (provide for Amendments and Conversions of existing permits) <br />The application for a Constmction Materials Rebndaz 1 l2 Operation Reclamation Permit contains three major parts: {1) the application <br />form; (2) Exhibits A-S, Addendwn 1, any sections of Exhibit 6.5 (Geotechnical Stability Exhibit; and (3) the application fee. When you <br />submit your application, be swe to include one (l) complete signed and notarized ORIGINAL and one (1) copy of the completed <br />application form, two (2) copies oflixhibits A-S, Addendum 1, appropriate sections of 6.5 (Geotechnical Stability Exhibit, and a checkfor <br />the application fee described under Section (4) below. Exhibits should N01' be bound or in a 3-ring binder; maps should be folded to <br />R I; 2" X i l" or R 1/2" X 14"size. '1'o expedite processing, please provide the information m the format and order described ut this form. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, ip the space provided, AI,I, information requested below. <br />I. Auplicant/ooerator or company name !name to be used on oermitl: __SrS€19-+•S-LarsoLi/ __,_ <br />1.1 Type of organization (corporation, partnership, etc.): Individual <br />2. OJteration name (pit. mine or site name): <br />3. Permitted acreage fnew or ezistine site): <br />3.1 Change in acreage (-r) <br />3.2 'Dotal acreage in Petmit area <br />4. F'ecs: <br />4.1 New Application <br />4.2 New Quarry Application <br />4.4 Amendment Fee <br />4.S Conversion to l 12 operation (set by statute) <br />permitted acres <br />_ ,-~ _ acres <br />' acres <br />F. ~ !. ~. i <br />L „i 3 .0 application fee <br />- _, __ , .,~ $2.906.00 quarry application <br />_~~93R.00 amendment fee <br />$2.344.00 conversion fee <br />5. Primary commoditiefsl to be mined: Gravel .S t~l-_ ~~r2y_____ <br />5.1 Incidental commodities} m be mined: I . _________._, _ ___,._ Ibs('TonslK <br />3. ____~ Ibs/Tonsivr <br />4. ____ / Ibsr"I'ons/4T <br />2. 1 ____. IbsTons/vr <br />5. _ IbsPfons/yr <br />5.2 Anticipated end use oi'primary commoditie(s) to be mined: f'n„crr„r•r; nn marnr; ~ _____`_ <br />5.3 Anticipated end use of incidental commoditie(s) to he mined: ____,_____..__.___,___.__.___________,______ _ <br />OHice of Office n( <br />Mints! land Reclamation Active and Inactive Mines <br />