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<br />0 <br />0 <br />HATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />Department of Natural Resources <br />1313 Sherman St.. Room 215 <br />Denver. Colorado 80203 DIVISION Of <br />Phone: (303) 866-3567 CONSTRUCTION MATERIALS M I N E RA L <br />FAX: 1303) 832-8106 REGULAR (112) OPERATION & <br />GEOLOGY <br />RECLAMATION PERMIT APPLICATION FORM QC/4lir-11k or-&- R E C L A M A T I O N <br />MINING-SAFETY <br />MAY 18 2001 Bill o-ens <br />CHECK ONE: There 6 a File Number Already Assigned to this Operation Govemor <br />, Greg eDDirector <br />Permit # 77 - 486 Divi ion t Mineralls a d G1 <br />1L _ _ (Please reference the file number currently assigae? to tL operatton? <br />Michael B. Long <br />New Application (Rule 1.4.5) Amendment Application (Rule 1.10) Division Director <br />% Conversion Application (Rule 1.11) <br />Pernnit # M - (provide for Amendments and Conversions of existing permits) <br />The application for a Construction Materials Regular 112 Operation Reclamation Permit oontains three major parts: (1) the application form. <br />(2) Exhibits A-S, Addendum 1, any sections of Exhibit 6.3 (Geotechnical Stability Exhibit: and (3) the application fee. When you submit your <br />application, be sure to include one (1) mWlete sigged and notarized IVORY ORIGINAL and four (4) copies of the completed ivo <br />application form, five (5) copies of Exhibits A-S, Addendum 1, appropriate sections of 6.5 (Gootechnical 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 1/2" 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 described below. <br />1. ADDIkant/OOerator or company name name to be used on permit <br />BACA COUNTY <br />1.1 Type of organization (corporation, partnership, etc.): GOVERNMENTAL ENTITY <br />1.2 I.R.S. Tax I.D. No. or Social Security Number: 84-6000744 <br />2. Ope ration name (if t. mine or site name): GRAVEL PIT NO. 7 <br />3. Permitted aerea¢e (new or emdating site): 1.7 permitted acres <br /> 3.1 Change in acreage (+) 158.3 _ acres <br /> 3.2 Total acreage in permit area _ 160- acres <br />4. Fees: <br /> 4.1 New Applicadion 344.00 application fee <br /> 4.2 New Quarry <br />Application 12-M-00 quarry application <br /> 4.4 Amenddment Fee <br />Amendment X438.00 amendment fee <br /> 4.5 Conversion to 112 operation (set by statute) 2.344.00 conversion fee <br />5. Pd M8rv commod)tle(s) to be mined: GRAVEL SAND <br /> 5.1 Incidental commoditie(s) to be mined: 1. / Ibs/Tonslyr 2. J lbslToos/vr 3. / l s/Tons/vr <br /> 4. / Ibs/lbns/vr 5. / lbs/Tons/vr <br /> 5.2 Anticipated end use of primary commoditie(s) to be mined: WHEN SAND AND GRAVEL SUPPLY IS DEPLETED <br /> 5.3 Anticipated end use of incidental commoditie(s) to be mined: N/A