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STATE OF COLORADO <br />DIVISION Of RECLAMATION, MINING AND SAFETY <br />Department of Natural Resources <br />1313 Sherman St., Room 215 <br />Denver, Colorado 80203 C O L O RA D O <br />o t v i c t ON OF <br />Phone: (3031866-3567 RECLAMATION <br />FAX: (303) 8323106 CONSTRUCTION MATERIALS MINING <br />REGULAR (112) OPERATION SAFETY <br />RECLAMATION PERMIT APPLICATION FORM <br />Sill Ritter, Jr. <br />Governor <br />CHECK ONE: 'there is a File Number Already Assigned to this Operation Harris 0. Sherman <br />Executive Director <br />Permit # M - - (Please reference the file number currently assigned to this operati(pa,, W. carr7r,y <br />New Application (Rule 1.4.5) Amendment Application (Rule L I0) D+w,'on Director <br />Natural Resource Trustee <br />Conversion Application (Rule 1. {1) <br />Permit # _- Lt (provide for Amendments and Conversions of existing permits) <br />The application for a Construction Materials Regular 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 application fee. When you <br />submit your application, be store to include one (1) complete signed and notarized ORIGINAL and one (1) copy of the completed <br />application form, two (2) copies of Exhibits A-S, Addendum 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 to <br />8 1 i2" X I I" or 8 112" X 14" size. To expedite processing, please provide the information in the format and order described in this form. <br />GENERAL OPERATION INFORMATION <br />'t'ype or print clearly, in the space provided, ALL information requested below. <br />1. Applicant/operator or company name (name to be used on permit: <br />I.1 Type of organization (corporation, partnership, ctc.): , <br />2. Operation name (pit. mine or site name): <br />J <br />3. Permitted acreage (new or existing site): 8y 4, 3 permitted acres <br />3.1 Change in acreage (+) - acres <br />3.2 Total acreage in Permit area acres <br />4. Fees: <br />4.1 New Application $2,696.00 application tee <br />4.2 New Quarry Application $3,342.00 quam, application <br />4.4 Amendment Fee $2.22%Q0 amendment fee <br />4.5 Conversion to 112 operation (set by statute) _$2.,696.00 _ conversion fee <br />`` <br />_. <br />5. Primary cotttmoditie(s) to be mined: d14 <br />5.1 Incidental commoditie(s) to be mined: 1. tbsll'onslvr 2. <br />._.._W... __.._..W..._ <br /> 3. lbsrrotW 4.._._ bs <br />," <br />Lgq <br />!yr 5.... _._ _ . r ..._..--- ---IbS*ron,,;/vr <br />5.2 , <br />, <br />? <br />Anticipated end use of primary corrnrroditie(s) to be mined: <br />5.3 Anticipated end use of incidental commoditie(s) to he mined: __• _r,4 <br />___ <br />______ <br />_ __________._ <br /> <br /> <br />Office of Office of -? <br />Mined Land Reclamation Denver • Grand ]unction • Durango Active and Inactive Mines