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77 <br /> STATE OF COLORADO <br /> DIVISION OF MINERALS AND GEOLOGY <br /> Department of Natural Resources <br /> orY'$Denver, E R Ur <br /> 1313 Sherman 51.,Room 115 M I N A L S <br /> Phone:D03)r866-35673 RECEIVED GEOLOGY <br /> FAX: (303)631-8106 •e CL..NATION <br /> N I,NNG•S•t E TT <br /> CONSTRUCTION MATERIALS AUG 17 1999 sdl Dwrns <br /> LIMITED IMPACT (110) OPERATIpJlm cfes . <br /> Vision of Minerab&Geology <br /> RECLAMATION PERMIT APPLICATION FORM Gres EWarcher <br /> E.ecurne Director <br /> nuchxl s.tons <br /> Dna W, <br /> CHECK ONE: XX New Application (Rule 1.4) _ Amendment Application (C.R.S. 34-32.5-110) <br /> _ -Conversion Application (Rule 1.11) <br /> �.J Permit # 1!1I -� 0 � - provide for Amendments and Conversions of exist- <br /> ing permits) <br /> This application for a Limited Impact (110) Operation Reclamation Permit contains three major <br /> parts: (1) the application form; (2) Exhibits A-J, Exhibit L, Addendum 1, any sections of Exhibit <br /> 6.5 (Geotechnical Stability Exhibit; as required by the Office, and outlined in Rules 6.1, 6.2, <br /> 6.3, 6.5 and 1.6.2(1) (b); and (3) the application fee. When you submit your application, be sure <br /> to include one (1) signed end notarized IVORY ORIGINAL and one (1) copy of the completed ivory <br /> application form, two (2) copies of Exhibits A-J, Exhibit L, Addendum 1, appropriate sections of <br /> 6.5 (Geotechnical Stability Exhibit) as required, and a check for the application fee described <br /> under Section (4) below. Exhibits should NOT be bound or in 3-ring binders; maps should be folded <br /> to 8 1/2" X 11" or 8 1/2" X 14" Size. To expedite processing, please provide the information in <br /> the format and order described in this form. <br /> GENERAL OPERATION INFORMATION <br /> Type or Print clea e space provided, all information described below. <br /> 1. Applicant/Operator Name (name to be on Permit): Byron 4 LaLani Weathers <br /> 1.1 Type of Organization (corporation, partnership, etc. ) : Individual <br /> 1.2 I.R.S. Tax ID No. or Social Security No. : 84-0854306 <br /> 2. Operation Name (Pit, mine or site name) : Weathers Mine #1 <br /> 3. Permitted Acres (new or existing site): 9.99 permitted acres <br /> 3.1 Change in (+ or -) ------ acres <br /> 3.2 Total acres in Permit area 9.99 acres <br /> 4. Fees: <br /> 4.1 New Application: $875.00 application fee <br /> 4.2 Amendment Fee: $5a3+6B application fee <br /> 4.3 Conversion Fee ( from 110d to 110 44, conversion fee (Rule 1.11.2(2) <br /> 5. Primary commodities(:) to be mined: borrow Sand clay <br /> 5.1 Incidental commodities(s) to be mined: 1. / lbs/Ton/yr <br /> 2. / lbs/Ton/yr 3. / lbs/Ton/yr <br /> 4. / lbs/Ton/yr 5. / lbs/Ton/yr <br /> 5.2 Anticipated end use of primary commodities(s) to be mined: construction materials <br /> 5.3 Anticipated end use of incidental commodities(s) to be mined: <br />