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STATE OF COLNII?IAIIINNRI <br /> <br />DIVISION OF MINERALS AND GEOLOGY <br />nrparlnnrl of Natural Resources <br />i 113 Six-rrn m St., Room 215 <br />Den%xY. crA»arlu M-03 <br />Phsuto• 110 1) 866.3567 <br />FAX: 111)11 832-8106 <br />RECEIVED <br />SEP 1.0 2001 <br />RECEIVED <br />AUG 2 ; 2001 <br />1 <br />DEPARTMENT OF ' <br />NATURAL <br />RESOURCES <br />Roy Romer <br />Governor <br />lames S. Lochhead <br />Executive Director f <br />Michael a_ Long <br />Division Director <br />Division of Minerals and Goolm <br />Division of Minerals and Geology <br />CONSTRUCTION MATERIALS <br />REGULAR (112) OVSRA?TION <br />RECLAMATION PERMIT APPLICATION FORM <br />CHECK ONE: New Application (Rule 1.4.5) Amendment Application (Rule 1.10) <br />X Conversion Application (Rule 1.11) <br />Permit A M - 77 - 479 - (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 signed and notarized IVORY ORIGINAL and four (4) <br />copies of the completed Ivory application form, five (5) copies of Exhibits A-S, 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 11' 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 />AMA --- 4w-w 00 <br />GENERAL OPERATION INFORMATION <br />Type or priat clearly, in the space provided, ALL information requested below. <br />1. Applicant/operator or comaaaY name (name to be used on permit): <br />BACA COUNTY ROAD & BRIDGE DISTRICT #1 <br />1.1 Type of organization (corporation, partnership, etc.): COUNTY ROAD & 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 name): WALSH PIT NO. 2 <br />Permitted acreage (new or existing site): 5,2 <br />permitted acres <br />3.1 Change in acreage (+) 74.8 acres <br />3.2 Total acreage in Permit area 80x,0 acres <br />4. Fees: <br />4.1 New Application SI,875.00 application fee <br />4.2 New Qu#rry Application $2,325.00 quarry application <br />4.3 Milling Application (Non-OMO) $3,100.00 milling application <br />4.4 Amendment Fee $1.550.00 amendment fee <br />4.5 Conversion to 112 operation (set by statute) 51.875.00 conversion fee <br />5. PrimaEX commoditie(s) to be mined: GRAVEL <br />5.1 Incidental commoditie(s) to be mined: 1. lbs/Tons/vr <br />2. / lbs/Tons/vr 3. / lbs/Tons/yr <br />4. lbs/Tons/vr 5. / lbs/Tons/vr <br />5.2 Anticipated end use of primary commoditie(s) to be mined:UNTIL GRAVEL. IS DEPLETED <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: