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l//V -,-76o?/--o?7 <br />RECEV <br />CONSTRUCTION MATERIALS / OCT 2 6 2004 <br />REGULAR (112) OPERATION Division of Mii,ai. . <br />RECLAMATION PERMIT APPLICATION FORM <br />CHECK ONE There Is a File Number Already Assigned to tbi9 Operation <br />Permit # Ica-_ (Please reference the file number currently assigned to this operation) <br />_ X New Application (Rule 14 5) Amendment Application (Rule 1.10) <br />Conversion Application (Rule 111) <br />Permit g M (provide for Amendments and Conversions of existing permits) <br />The application for a Construction Matenal5 Regular 112 Operation Reclamation Permit contains three mayor parts (1) the application <br />form, (2) Exhibits A-S, Addendum 1, any sections of Exhibit 6.5 (Geotechnical Stability Exhibit, and (3) the application fee. When you <br />submit your application, be sure to include one (1) complete suited and nomri d ORIGINA4 and one (1) copy of the completed <br />application form, two (2) copies of Exhibits A-S, Addendum 1, appropriate sections of 6.5 (Geotechnica) Stability Exhibit, and a check for <br />the application fee described under Section (4) below Exhibits should L1QT be bound or in a 3-nng binder, maps should be folded to <br />8 112" X ( t" or 8 112' X 14" size. To expedite processing, please provide the tnformatton is the format and order described to this form <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, In the space provided, ALL information requested below. <br />I AAipl_icantlonorator or company name fnatne to be used on tierrnft): Clear Creek District Water Provider-s. LL <br />1 I Type of organization (corporation, partnership, etc.): Limited Liability Corporation <br />1 2 1 R.S Tax I D No or Social Security Number 20-14C)P399 <br />/ <br />2. 02g ahr •on name Zit, mine or site name): MMRR Quarry V <br />3 Permitted ecreaeA (new o exhane site) <br />3 1 Change in acreage (+) <br />3 2 Total acreage in Permit area <br />526.70 permitted acres <br />acres <br />526. 7_ acres <br />4 Fees. <br />41 New Application <br />t/4 2 New Quarry Application <br />4 4 Amendment Fee <br />45 Conversion to 112 operation (set by statute) <br />_ $2.34400 application fee <br />$2.906.00 quarry application <br />$1.93&00 amendment fee <br />52.344 00 conversion fee <br />5 Primary commoditie(s) to be mined: SPOCiftCation Construction Aggregates <br />51 Incidental commoditie(s) to be mined: 1 N/A - IbslTonsN 2 /_ Ibs r <br />3 1 ) s/Tons/vr 4 ! J s/Tons/xr 5. / lbs/Tonslvr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: Construction Aggregates (all types) <br />5 3 Anticipated end use of incidental commoditie(s) to be mined. N/A <br />0001