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<br />• 0 <br />5 RATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY RFCEwED <br />Department of Natural Resources ces <br />1313 Sherman St.. Room 215 <br />D 1 v I S I O N OF <br />Denver. Colorado 80203 MAY O ?ho? <br />Phone: (303) 866.3567 CONSTRUCTION MATERIALS M O U MINERAL S <br />FAX: (303) 832.8106 )REGULAR (112) OPERATION & <br />Division of Minerals and Gaolo E O LOG Y <br />RECLAMATION PERMIT APPLICATION FORM R E C L A M A T 10 N <br />MINING-SAFETY <br />Bill Owens <br />CHECK ONE: There is a File Number Already Assigned to this Operation Governor <br />. Walther <br />eg E <br />Executive <br />eg E Director <br />Permit# -M-.-Z7-485 <br />-, (Please deference the fde number currently assigned to this operation) Gr <br />New Application (Rule 1.4.5) Amendment Application (Rule 1. Michael a. Lang <br />10) Division Direcror <br />-I-- Conversion Application (Rule 1.11) <br />Permit # - M - 77 - 485 - (provide for Amendments and Conversions of existing permits) <br />The application for A Construction Materials Regular 1 t 2 Operation Reclamation Permit ooatains three major parts: (1) the application form: <br />(2) Exhibits A-S, Addendum 1, any sections of Exhibit 6.5 (Geotechuical Stability Exhibit; and (3) the application fee. When you submit your <br />application, be sure to include one (1) ccornglete sinned and notarized IVORY ORIGINAL and four (4) copies of the completed jv-gdy <br />application form, five (5) copies of Exhibits A-S, Addendum 1. appropriate sections of 6.5 (Geotochnical 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 11" or 8 1/2" 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 apace provided, all information described below. <br />1. A <br />BA pplicant/operator or company-name „(pame tQ be used on uermfN: <br />CA 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: R4-6000744 <br />2. Ope ration name (nit mine or site name): GRAVEL PIT NO. 8 <br />3. Perm itted acreage faew ore lss ft site): .1 permittedscres <br /> 3.1 Change in acreage (+) <br />159 acres <br /> 3.2 Total acreage in Permit area 160.0 acres <br />4. pores : <br /> 4.1 New Application <br />52.344.00 application fee <br /> 4.2 New Quarty Application $2.906.00 quarry application <br /> 4.4 Amendment Fee 51.938.00 amendment fee <br /> 4.5 Conversion to 112 operation (set by statute) 52.]44.00 conversion fee <br />5. Primary commoditle(s) to be mined: SAND GRAVEL <br /> 5.1 Incidental commoditie(s) to be mined: 1. / Ibs/ on 2. / Ibsao aa/vr 3 <br />/ lbs/T <br />/ <br /> . <br />ons <br />?r <br /> 4. / Ibs/Co?,c/ylI 5. / lbs/P ons/vr <br /> 5.2 Anticipated cad use of primary commoditie(s) to be mined: WHEN SAND /GRAVEL IS DEPLETED <br /> 5.3 Anticipated end use of incidental commoditie(s) to be mined: NIA