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<br />STATE OF COLORADO <br />DIVISION <br />tment of Natural Rewurcm D GEOLOGY R E. CE!VED <br />1313 Sherman St., Room 21 S <br />Phone: (303) 866-3567 <br />FAX: (303) 832-8106 <br />Division of Minerals and Geology <br />FILE COPY CONSTRUCTION MATERIAM <br />REGUILAR (113) OPERATION <br />FOR SCANN/A 27 <br />'IONPERMITAPPLICATIONFORM <br />CRECK ONE: Thy n is A Rk Nuamber Ah vady Aadgped to tb b Operation <br />Permit # M 43-Arl'f' (Please referc=dra fife anmbar amen ty as igwd to ft operation) <br />x _ Now Apphosi im (R1mie 1.4.5) Amendment Application (Role 1.10) <br />Conversion Application (Role 1.11) <br />Pew # A= (prnvido for Antendiineub and Converalons of existing penrib) <br />Hinds Pit # 35 <br />The application for a Ca mMmian M knob Rapdar 112 Opas on Rmlamation Permit eontatrms duee =a* pun: (1) go epp&aWn form, <br />(2) Exhibits AA Addendum 1, any sew at xb %k 65 (OeotoclInical Stability Exhibit; and (3) &a application fee. Whorl yon submit your <br />application, be we 14 include one (1) 22m ft jgE d and ggyg&ad WMY ORI? aard are (1) copy of the complewd vocy applcafion <br />form, two (2) copies of Fadabila A-S, Addendum 1, appr+op t iate sections of 6.5 (Gootioohaical Stability Eadnbit, and a cleock for the application <br />foe desciribed under Section (4) below Factni/ida should NOT be bound or is a 3-rog binder, maps shouts be folded b 812" X 11" or 8 1/2" <br />X 14" size. To ap5die ptooessiag, please provide tbal Wommadw in the format and order descrmbed in dais form. <br />C MIERAL OPERATION INFORMATION <br />Type or print clearly, In the apace provided, AU brormation requested below. <br />1. AgggOnt/ooa #K or eomDamv name (aaime to be next on permit): Baca County <br />1.1 Type of ftwi a ka don (oaRwration, paraaship, etc.); eoverment: Entity <br />1.2 LRS. Tax I.D. No. or Social Security Number: 270033560 <br />2. Operation name fait. mj?ne ors' name): <br />3. PermMW acreage (new or existing site?: <br />3.1 C1wW in acreage (+) <br />3.2 Total acreage in Permit area <br />4. <br />DIVISION OF <br />MINERALS <br />GEOLOGY <br />DECLAMATION <br />MINING-SAFETY <br />610 Owens <br />covens <br />Greg E. WaWW <br />Executive Director <br />Rooaw W. Latta" <br />Ac ft Division Director <br />permitted acres <br />acres <br />100 <br />acres <br />4.1 Now Application 12.344.00 <br />app]ica>ion fee <br />4.2 New Quarry Application, 52,206.00 quarry application <br />4.4 Amendment Fee $1.938.00 amendm,ew fee <br />4.5 Conversion to 112 operation (set by statute) $2344.00 conversion fee <br />5. Prim alneommoditiefs) to be mined: e,.A.re 1 sand <br />5.1 Incidental coaamoditie(s) to be mined: 1. - lbs4ons/vr 2. 1 lb s/fons/yr <br /> 3. / Ibs/1 4. / lball •/ 5. ! b s/Tons/vr <br />5.2 Anticipated end useofprimarycommoditie(s)tobemined.- When supply ii$ depleted. <br />5.3 Andc ipatod end use of incidental eoun noditie(s) to be mined: N /A