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DEPARTMENT OF PLANNING SERVICES <br />918 Tenth St Greeley CO 80631 <br />Phone (970) 353-6100 x3540 Fax (970) 304-6498 <br />USE BY SPECIAL REVIEW (MINING OPERATION) APPLICATION <br />FOR PLANNING DEPARTMENT USE DATE RECEIVED: RECEIPT <br /># /AMOUNT # /$ CASE # ASSIGNED: <br />APPLICATION RECEIVED BY PLANNER ASSIGNED: <br />To be completed by APPLICANT is accordance with procedural guide requirements: <br />1. I (we), the undersigned, hereby request a hearing before the Weld County Planning Commission concerning <br />a proposed Gravel (gravel, coal, borrow pit, etc.) mining operation for the following described <br />unincorporated area of Weld County: <br />Legal Description See Attached Section _, Township _ North, Range -West <br />Flood Plain: See Sheet 3 Zone District: Agg Total Acreage: 496 total Overlay District: Flood <br />Geological Hazard: , Airport Overlay District: <br />2. Surface owner(s) of area of land described <br />Name: See attached <br />Name: <br />Address: Phone: <br />Address: Phone: <br />3. Owner(s) of mineral rights or substance to be mined <br />Name: See Attached Address: <br />Name: Address: <br />Phone: <br />Phone: <br />4. Applicant's name: Aggregate Industries, WCR Inc. Email Address Connie.davis@aggregate.com <br />Address: 1707 Cole Blvd. Golden, CO 80401 Phone: (970)336-6526 <br />5. Identify any prior permits for mining held by applicant or affiliated person: <br />AM USR -897 <br />I (We) hereby depose and state under penalties of perjury that all statements, proposals, and/or plans submitted <br />with or contained within the application are true and correct to the best of my (our)knowledge. Signatures of all fee owners <br />of property must sign this application. If an Authorized Agent signs, a letter of authorization from all fee owners must be <br />i ded with the application. If a corporation is the fee owner, notarized evidence must be included indicating that the <br />ig tory s the g u o 'ty o sign for the corporation. <br />Signature: Owner or utho ized Agent Dat Signature: Owner or Authorized Agent Date <br />15