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STATE OF COLORADO <br />t~ ~ _ _ <br />R DIVISION Of RECLAMATION, MINING AND SAFETY ~~ <br />~~• Department of Natural Resources , '-~ ~Q p ~ ~ r ~ t ~~ I ~ <br />p~,,~ ~)CN~~~ ~ ~ ~ - ~ COLORADO <br />;~~~ 1313 Sherman 5t., Room 215 <br />DIVISION O F <br />c~„? <br />.,~~ Denver, Colorado 80203 CONSTRUCTION MATERIALS. RECLAMATION <br />M ~• Phone: (303) 866-3567 M I N I N G <br />':`- FAX: (303) 832-8106 REGULAR (112) OPERATION <br />,,,~ SAFETY <br />r "°' RECLAMATION PERMIT APPLICATION FORM <br />Bill Owens <br />Governor <br />CHECK ONE: There is a File Number Already Assigned to this Operation Russell George <br />l rve Director <br />Permit # M -!~-~.-~' (Please reference the file number currently assigned to this operaR w Cattany <br />New Application (Rule 1.4.5) Amendment Application (Rule 1.10) pivision Director <br />Natural Resource Trustee <br />l~ Conversion Application (Rule 1.11) <br />Permit # M -~~ -~--~ (provide for Amendments and Conversions of existing permits) <br />The application for a Constnzction Materials Regulaz 112 Operation Reclamation Permit contains three major parts: (1) the application <br />form; (2) Exhibits A-S, Addendum 1, any sections of Exhibit 6.5 (Geotechnical Stability Exhibit; and (3) the applcicoati of the cohe feted <br />submit your application, be sure to include one (1) complete sil~ned and notarized ORIGINAL and one (1} py mP <br />application form, two (2) copies of Exhibits A-S, Addendum 1, appropriate sections of 6.5 (Geotechllical Stability Exhibit, and a check for <br />the application fee descnbedl 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 11" 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 print clearly, in the space provided, ALL information requested below. <br />S i 0_n~~~iJ~ac ~ ALr ~ ~'~~-~_. <br />1. Analicant/operator ar company name (name to be used on aermit): <br />1.1 Type of organizsttion (corporation, partnership, etc.): r rJ/~f~ R ~~ ~~, <br />2. <br />Operation name (pit., mine or site name): <br />-- - - - 3: - Perrru'Reaacreage (view orr ez><s ><~sftel: - <br />3.1 Change in acreage (+) <br />3.2 Total acreage in. Permit azea <br />- ~ T D1-~- __-- ~errniitgd-acrES - <br />s acres <br />~~` 7S acres <br />4. Fees: ~ . 2 3.00 application fee <br />4.1 New Application ~ $2 906,00 quarry application <br />4.2 New Quarry Application $1 938.00 amendment fee <br />4.4 Amendment Fet: <br />rsion to 112 operation (set by statute) <br />C $2,344.00 conversion fee <br />4.5 onve <br />~ ~ ~~ tNoiu~ l~G 5 <br />d <br />i <br />S~~~~ ~ ~ ~~ <br />5. Prim <br />1 <br />5 : <br />ne <br />ary commoditie~(s1 to be rn <br />Incidental commoditie(s) to be mined: 1. ~ni. ~a ~DA~-~bsiTons/vr / <br />2' 1bslTons/ <br />. lbs/Tons/yr 4. / lbs/Tons/vr Sr / lbs/Tons/~_+r <br />5.2 Anticipated end. use of primary commoditie(s) to be mined: <br />5.3 Anticipated end. use of incidental commoditie(s) to be mined: b ~ <br />;,~...~ ~- car.=-P~ <br />Office of <br />Minarl I and Rarlamatinn <br /> <br />Office of <br />Alive and Inactive Mines <br />