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<br />999 <br />STATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />Department of Natural Resources <br />1313 Sherman St.. Room 215 <br />Denver. Colorado 80203 <br />RFC <br />A'-? <br />Phone: (303) 866-3567 CONSTRUCTION MATERIALS <br />FAX: (3031832 8106 REGULAR (112) OPERATION ?UN Z40 <br />RECLAMATION PERMIT APPLICATI044,911M /69 <br />113% <br />0f41y'era/s o' <br />OC@0/o <br />91JECK ONE: There Is a File Number Already Assigned to this Operation <br />Permit # _- 78- 225. L (Please reference the file number currently assigned to this operation) <br />New Application (Rule 1.4.5) Amendment Application (Rule 1.10) <br />X Conversion Application (Rule 1.11) <br />Permit # M .78 -225 - L (provide for Amendments and Conversions of adsting permits) <br />DI VI S I O N 0 <br />MINERALS <br />GEOLOGY" <br />.RECLAMATION <br />MINING-SAFETY <br />&P Owens <br />Govermw <br />Greg E. Watcher <br />Execmive Oirecror <br />Michael8 Lang <br />Dnrsron Director <br />The application for a Construction Materials Regular 112 Operation Reclamatioa Permit contains three major parts: (1) the application form; <br />(2) Exhibits A-S. Addendum 1, any sections of Exhibit 6.5 (Gootechnical Stability Exhibit; and (3) the application fee. When you submit your <br />application, be sure to include one (1) gM ete sismed and notarized IVORY ORIGWAL and four (4) copies of the completed Ivory <br />application form, five (5) copies of Exhibits A-S. Addendum 1, appropriate sections of 6.5 (Gootechnical 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 12" X 11 " or 8 12" 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, allInformation described below. <br />AQpliaunt/ooerator or QAny o_= (game to be used on permit): <br />BACA COUNTY <br />1.1 Type of organization (corporation, partnership, etc.): GOVERNMENTAL ENTITY/ROAD S BRIDGE DISTRICT III <br />1.2 I.R.S. Tax I.D. No. or Social Security Number: 84-6000744 <br />pw <br />2. Otzerat '614A, <br />qu grime (nit. mine or aite name): McVEY PIT -i?it3:--?6 <br />3. Perm itted acreaoe (new or enis m sitey 8 , U permitted acres <br />3.1 Change in acreage (+) <br />?.151...4L <br />_ acres <br />3.2 'T'otal acreage in Permit area 16=00 ! acres <br />4. FW : <br />4.1 New Application 52.344.00 application fee <br />4.2 New Quarry Application IZ-9-06-00 - quarry application <br />4.4 Amendment Fee 11.938.00 amendment fee <br />4.5 Conversion to 112 operation (set by statute) X44.00 conversion fee <br />5. Primary commoditle(s) to be mined: SAND GRAVEL <br />5.1 Incidental commoditie(s) to be mined: 1. 1 Ibs/Tooslvr 2. 1 )bs/Toplft 3. Ibs/Ton0a <br /> 4. / Ibs/Tonslvr 5. 1 lbs/Tongff <br />5.2 Anticipated end use of primary commoditie(s) to be mined: 1ZT71 SUP LY IS DEPLETED <br />5.3 Anticipated end use of incidental commoditic(s) to be mined: NIA