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TATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />Department of Natural Resources <br />0113 Sherman St., Room 215 <br />Denver, Colorado 80203 D I v i S I O N O f <br />Phone: (303) 866.3567 CONSTRUCTION MATERIALS M I NN EE RA L 5 <br />FAX: 1303) 832-8106 REGULAR (112) OPERATION & <br />GEOLOGY <br />RECLAMATION PERMIT APPLICATION FORM RECc"IVE R E C L A M A T I O N <br />MINING - SAfET, <br />MAY 18 2001 Bill taken' <br />CHECK ONE: There is a File Number Already Assigned to this Operation Governor <br />Permit # 77. 484 Di vi Ion (Miners s aid Gt?tli.eo`ector <br />_ (Please reference the file number currently assigne? to tQirs operalton <br />Michael S. Long <br />New Application (Rule 1. 4.5) Amendment Application (Rule 1.10) Division Director <br />% Conversion Application (Rule 1.11) <br />Permit # M - - (provide for Amendments and Conversions of existing permits) <br />The application for a Construction Materials Regular 112 Operation Reclamation Permit oontaim three major parts: (1) the application form; <br />(2) Exhibits A-S, Addendum 1, any sections of Exhibit 6.5 (Geotechoical Stability Exhibit: and (3) the application fee. When you submit your <br />application, be sure to include one (1) giagplete sigged and nola gd IVORY ORIGINAL and four (4) copies of the completed vo <br />application form, five (5) copies of Exhibits A-S, Addendum 1, appropriate sections of6.5 (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 1R" X 11" or 8 1/2" X 14" size. To expedite processing, piesse 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, ali Information described below. <br />1. Applicant/operator or companv name name to be used onpermit <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. Operation name (p_rt,,mine or site name): GRAVEL PIT N0. 7 <br />3. Permitted aereaat (pew or _eft 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. feel: <br />4.1 New Application 1244 00 application fee <br />4.2 New Quarry Application $2,M.00 quarry appticarim <br />4.4 Amendment Fee S1„238,00 amendment fee <br />4.5 Conversion to 112 operation (set by statute) 2.344.00 conversion fee <br />5. Pt "rrv commodttle(s) to be mined: GRAVEL SAND <br />5.1 Incidental commoditie(s) to be mined: 1. / Ibs/Poos {yr 2. / lbs/rotts/vr 3. / l s/Pons/vr <br /> 4. / lbs/Poo s/vr S. I lbs/Tons/vr <br />3.2 Anticipated end use of primary commoditie(s) to be mined: WHEN SAND AND GRAVEL SUPPLE IS DEPLETED <br />5.3 Anticipated end rue of incidental commoditie(s) to be mined: - N/A