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<br /> <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 t__ ION o f <br />Phone: (303) 866-3567 CONSTRUCTION MATERIALS ERAL 5 <br />FAX; 1303) 832-8106 REGULAR (112) OPERATION & <br />OLOGY <br />RECLAMATION PERMIT APPLICATION FORM REC r-1 R E CL A M A T 10 N <br />R 1Q V MINING-SAFETY <br />MAY 18 2001 Sill Owens <br />Governor <br />CHECK ONE: There is a File Number Already Assigned to this Operation Gove <br />' Greg rr Walchei <br />Permit # jN - 77. 484 (Please reference the file number currently assigGtae? to t?iisMopera ioo?d G ?"e Director <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 Conshvction Materials Regular 112 Operation 11=19mation Permit contains three major parts: (1) the application form- <br />(2) Exhibits A-S, Addendum 1, any sec Ww of Exhibit 6.5 (Geoteelmical Stability Exhibit: and (3) the application fee. When you subunit your <br />application, be sure to include one (1) late sigited?tarized 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 (C,ootechnical 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 I V or 81/2" 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 (eformatfoa described below. <br />L Applicant/operator 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. ORI Mtion name fptt. mine or slue name): GRAVEL PIT NO. 7 <br />3. Perm itted aerelsel (new or ezisdna she): 1.7 permitted acres <br />3.1 Change in acreage (+) 158.3 _ acres <br />3.2 Total acreage in Permit area _ 16. acres <br />4. Fees: <br />4.1 New Application x.344.00 application fee <br />4.2 New Quarry Application 12.446.00 quarry application <br />4.4 Amendment Fee 11,938,00 amendment fee <br />4.3 Conversion to 112 operation (set by statute) $2.344.00 conversion fee <br />5. Prim ary commodhle(s) to be mined: GRAVEL SAND <br />5.1 Incidental commoditie(s) to be mined: 1. / ft Ton 2. / lbsfrons/vT 3. / lbsfrons/vr <br /> 4. / Ibsffons'Yr 5. r msfroalhT <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