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99 -STATE <br />(t-COLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />4t•1hittmenl Of Natural Resources I Will <br />1 !! 3 5ht•rman St.. Ruom 215 <br />1)1,nvvr. Colorado 80203 <br />llfwrw: 1 14) 11 BM-3567 <br />FAX: t to.;) 832.8106 vot <br />DEPARTMENT OF <br />NATURAL <br />CONSTRUCTION MATERIALS USO V ROES <br />REGULAR (112) OPERATION Roy Romer <br />RECIiAMATION PERMIT APPLICATION FORM covernor <br />Wmn S. Lochhead <br />Euewdve Director <br />Michael B. Long <br />Division Director <br />CHECK ONE: Now Application (Rule 1.4.5) Amendment Application (Rule 1.10) <br />X Conversion Application (Rule 1.11) <br />Permit N -M_- 23 - 087 - (provide for Amendments and Conversions of <br />existing permits) <br />The application for a Construction Materials Regular 112 Operation Reclamation Permit contains <br />three major parts: (1) the application form; (2) Exhibits A-S, Addendum 1, any sections of <br />Exhibit 6.5 (Geotechnical Stability Exhibit; and (3) the application fee. When you submit your <br />application, be sure to include one (1) complete sicned and notarized WORT ORIGINAL and four (4) <br />copies of the completed Ivory application form, five (5) copies of Exhibits A-$, Addendum 1, <br />appropriate sections of 6.5 (Geotechnical Stability Exhibit, and a check for the application fee <br />described under Section (4) below. Exhibits should NOT be bound or in a 3-ring binder; maps <br />should be folded to 8 1/2' X ll' or 8 1/2" X 14' size. To expedite processing, please provide <br />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 requested below. <br />=====ec=s.999.9999.999999a9na==c999999999999?oa=o9.9s9x===__--._"--_-_-- ____ ___ __ <br />1. ABplicant/operator or company name (name to be used on vermit). <br />BACA COUNTY ROAD b BRIDGE DISTRICT #1 <br />1.1 Type of organization (corporation, partnership, etc.): COUNTY ROAD .6 BRIDGE <br />1.2 I.R.S. Tax I.D. No. or Social Security Number: 84-6000744 <br />2. Operation name (nit, mine or site rime): WEEDEN LAND 6 CATTLE CO. PIT 'NO. 30 <br />3. Permitted acreage (new or existing site)-: 9.9 permitted acres <br />3.1 Change in acreage (+) 150.1 acres <br />3.2 Total acreage in Permit area 160.0 acres <br />4. Fees: <br />4.1 New Application _ 51,875.00 , application fee <br />4.2 New Quarry Application S2,325.00 quarry application <br />4.3 Milling Application (Non-DMO) _ $3.100.00 milling application <br />4.4 Amendment Fee 51,550.00 amendment fee <br />4.5 Conversion to 112 operation (set by statute) $1.875.00 conversion fee <br />S. Primary commoditie(s) to be mined: GRAVEL <br />5.1 Incidental co.moditie(s) to be mined: L. _ lbs/Tons/v- <br />2• - % lbs/Tons/vr 3. / Zbs/Tons/vr <br />4. % lbs/Tons/vr S. lbs/Tons/vr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: UNTIL GRAVEL IS D-p7..TFD <br />5.3 Anticipated end Lase of incidental commoditie(s) co be mined: <br />1