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<br />STATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />Departmepartment of Natural Resources <br />1311 Sherman St.. Room 215 <br />Denver, Colorado 80203 <br />Off <br />Phone: (303) 866.3567 CONSTRUCTION MATERIALS FAX: 1303) 832-8106 REGULAR (112) OPERATION RECLAMATION PERMTT APPLICATION FORb1 RECI'cIVE MAY 18 2001 Bill Owens <br />LZGEOLOG? <br />CHECK ONE: There Is a File Number Already Assigned to this Operation Governor <br />Division ( Minerals a d G eres t o ouector <br />Permit # - 77. 4$4_ (Please r efere»ce the File number currently assign ed to tQus operatron?1h <br />Michael B. Long <br />New Application (Rule 1. 4.5) Amendment Application (Rule 1.10) Division Director <br />K 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 contains three major parts: (1) the application form: <br />(2) Exhibits A-S, Addendum 1, any sections of Exhibit 6.5 (Geoteclmical Stability Exhibit: and (3) the application fee. When you submit vow <br />application, be sure to include one (1) e,&mplete sigggd and notarized IVORY ORIGINAL and four (4) copies of the completed ?m <br />application form, five (5) copies of Exhibits A-S, Addendum 1, appropriate sections of 6.5 (Geoteehnical 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 sbould be folded to <br />8 U2" X 11" 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, ad1 bnformation described below. <br />I. Apli kant/operator or company name (name to be used on permit <br />BACA COUNTY <br />1.1 T'ype 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. Oper ation name (pail, mine or slate name): GRAVEL PIT NO. 7 <br />3. Perm itted sereatt4 (new or e> bdug she): 1.7 permitted acres <br />3.1 Change in acreage (+) 158 - 3 acres <br />3.2 Total acreage in Permit area acres <br />4. Fees: <br />4.1 New Application SZi344,00 application fee <br />4.2 New Quarry Application $2.906.00 quarry application <br />4.4 Amendment Fee $1.23$,00 amendment fee <br />4.5 Conversion to 112 operation (set by statute) 2.344.00 conversion fee <br />5. Prim ary commoditle(s) to be mined: GRAVEL SAND <br />5.1 Incidental commoditie(s) to be mined: 1. / Ibs/Tons/Yt 2. / Ibs/fo_/vr 3. / l s/Toas/vr <br /> 4. / lbs/Tons/vr S. / ftri 0ns/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