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<br />HATE of COLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />Department or Natural Resources RECH VED <br />1313 Sherman St., Room 215 <br />Denver, Colorado 80203 MAY 18 ?AO? D I V I S I O N OF <br />Phone: (303) 866•3567 CONSTRUCTION MATERIALS 19H1 Y M I N E RA L 5 <br />FAX: (303) 832-8106 REGULAR (112) OPERATION - <br />&-Division of Minerals sod Geoto E O LOG Y <br />RECLAMATION PERMIT APPLICATION FORM a t c L w n A T I o N <br />MINING-SAFETY <br />Bill Owens <br />CHECK ONE: There is a File Number Already Assigned to this Operation eovernor <br />Greg E. Welcher <br />Permit # 1[ -X7.485 -_ (Ply ?'e?= the fde numbs currelitly assigned to this operation) Executive Director <br />Michael B. Long <br />New Application (Rule 1.4.5) Amendment Application (Rule 1.10) Division Director <br />_ X Conversion Application (Rule 1.11) <br />Permit # -M-- 7 7 _ 48 5 - (pie for Amendments aed Conversions of existing permits) <br />The application fora 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 (Geotechnical Stability Exhibit; and (3) the application fee. When you submit your <br />application, be sure to include one (1) comolete signed and notarized IVORY ORIGINAL and four (4) copies of the completed vory <br />application form, five (5) copies of Exhibits A-S, Addendum 1. appropriate sections of 6.5 (Geotechnical Stability Exhibit, and a check for <br />the application fee described under Section (4) below, Exhibits shouts NOT be bound or in a 3-ring binder, maps should be folded to <br />8 112" 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 space provided, all information described below. <br />1. Applkant/operator or companv n e game tq be used on permit): <br />RACA 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: 84-60on744 <br />2. Operation name (pit mine or site name): GRAVEL PIT NO. 8 <br />3. Perm itted sereaEe (pew or a-xbdng site 4.1 permitted acres <br />3.1 Change in acreage (+) <br />15 <br />() <br /> 5. acres <br />3.2 Total acreage in Permit area 160 <br />0 <br /> . acres <br />4. Femme, : <br />4.1 <br />4.2 New Applieatioo <br />New Quarry Application 52.344.00 application fee <br /> <br />4.4 <br />Amendment Fee $2.906.00 quarry application <br /> <br />4.5 <br />Conversion to 112 operation (set by statute) •9) 38.00 <br />S2.344.00 amendment fee <br />conversion fee <br />5. Primarv comm2d-hi- (a) to be mimed: SAND GRAVEL <br />5.1 Incidental commoditie(s) to be mined: 1. / lbstTonslvr 2 <br />I Ibs/J o <br />a/ 3 <br />/ I <br />l <br /> . _ <br />u a <br />. bsaon& <br />vr <br /> 4. / Ibs/r 1 / IbVroas /vr <br />5.2 Anticipated end 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 mired: -N/A