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f i III I III II I IIIIII III ~ ~ J.S~\/L\ ~L(/ f ~, L=~ <br />STATE of CoLOrzADo <br />DIVISION OF MINERALS AND GEOLOGY <br />Depanmemrn N,Irtval Resource9 RECEIVE \-~ <br />U 7) jherman SI . Room ? I5 <br />Denver, Cnloratla N0203 AUG 3 DIVISION O F <br />Phune: 1103) 86G-)Sb7 O 2000 M[ N E RA L S <br />cAx. uon nr_-eme & <br />Division of Minerals and ~I~~ L O G Y <br />CONSTRUCTION MATERIALS H EN I N GMS A F~ Y <br />REGULAR (112) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM s~il owe"s <br />Governor <br />Grcq E. Walther <br />Execmive Diroaar <br />CHECK ONE: _ New A licatian Rule 1.4.5 Amendment A licarion Rule 1.10((~`'~'chael s. Long <br />~~ PP ( ) PP ( Onision Director <br />~1Conversion Application (Rule 1.11) <br />Permit N M -~_-106 -_ (provide for Amendments and Conversions of existing permits) <br />The application for a Constnation Materials Regular 112 Operation Reclamation Permit cantaios three major parts: (1) the application form; <br />(2) Exhibits A-S, Addendum I, arty sections of Exhibit 6S (Geotechnical Stability Exhibit; and (3) the applicazion fee. When you submit your <br />application, be sure to include one (1) comHlete signed and notarized IVORY ORIGINAL and four (4) copies of the completed vo <br />application form, five {5) copies of Exhibits A-S, Addendtun 1, appropriate sections of 6.5 (Geotechnical Stability Exhibit, 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 m <br />8 I/2" X 11" or 8 1/2" X 14" siu. To expediu processing, please provide the information in the forma and order described in this form. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, iH the space provided, ALL information regoated bebw- <br />AppticaHUooerator or rnmoanv name (name [o be used on Hermit]: Mul lett's F:xaavati ng r T.e <br />1.1 Type oforgannation(corporation,parmership,rtc.): Limited Liability Comnanv <br />1.2 I.R.S. Tax I.D. No, or Social Security Number: <br />2. OHeratioHname(pitmioeorsitenamel: Mullett's c.acavatine Pit rrl <br />3. Permitted acrtaee f Hew or e:istine sitel: <br />3.1 Change in acreage (+) <br />3.2 Total acreage in Permit area <br />4. Fie <br />4.1 New Application <br />4.2 New Quarry Application <br />4.3 Mining Application (Non-DMO) <br />4.4 Amendment Fee <br />4.S Conversion to 112 operation (set by starute) <br />Class #6 rtaad base <br />S. Primary commoditie(s) to be mined: <br />5.1 incidental commoditie(s) to be mined: I. - Ibs/fons/vr <br />3. / Ibs?ons/vr 4. / IbslCons/vr <br />t0 permitted acres <br />~ acres <br />1,"~ acres <br />51.875.90 applicators fee <br />52325.00 quarry application <br />53.100.00 milling application <br />SI.SS0.00 amendment fee <br />51.875.00 conversion fee <br />2. / Ibs/fons/vr <br />5. / Ibs/fons/vr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: road main+.e naneP <br />5.3 Anticipated end use of incidental commoditie(s) to be mincd: <br />