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<br />01VISION OF MINERALS AND GEOLOGY <br />Department ui Natural Resources <br />131 i Sherman St.. Rnom 215 <br />Drnver, C010rado 1110203 <br />Phone: 13031 860.35677 <br />FAX: t 1031 R32.8106 <br />AuHiuigi?xi <br />NOV 0 5 2001 <br />Division of Minerals end Ceolow <br />CONSTRUCTION MATERIALS <br />REGULAR (112) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />CHECK ONE: New Application (Rule 1.4.5) <br />A Conversion Application (Rule 1.11) <br />OF COLORADO <br />DIVISION Of <br />j <br />MINERALS' <br />GEOLOGYII <br />RECLAMATION <br />MINING•SAFETY <br />Bill Owen <br />Governor <br />Greg E. Watcher <br />Executive Director <br />Amendment Application Rule 1.10?M1t"h?e1 B. t°"B <br />( Uiv?yon Director <br />Permit # _ M 019. (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 ofExhibk 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 nota ind IYORY ORIGINAL and four (4) copies of the completed h= <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 should YN0T 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 fort. <br />GENERAL OPERATION INFORMATION <br />Type or print dearly, In the space provided, U iatormatlon requested below. ,P,•w,?l ? i? <br />1. &Wlicant/ooerator or companv name (name to be used on permit): RACA COUNTY ?'- r - <br />1.1 Type oforganization (corporation. partnership, etc.): __ GOVERNMBNTAL ENTITY <br />1.2 I.R.S. Tax I.D. No. or Social Security Number: X84-6000744 <br />2. Operation name LR twine or ske name): HMELL PIT 132 <br />3. Permitted acreage (new or existing site): <br />3.1 Change in acreage H <br />32 Total acreage in Permit area <br />4. fg: <br />9.112 _ permitted acres <br />30 - 88 acres <br />40-00 acres <br />4.1 New Application S 1.875.00 application fee <br />4.2 New Quarry Application S2_325.00 quarry application <br />4.3 Milling Application (Non-DMO) milling application <br />4.4 Amendment Fee 51.550.00 amendment fee <br />4.3 Conversion to 112 operation (set by statute) S1,875-00 conversion fee <br />5. Prf_asy commodit[e(s1 to be mined; ROAD BED MATERIAL <br />5.1 Incidental commoditie(s) to be mined: 1. IbsfronsM 2. / Ibsfl'onsfvr <br />3. lbstrons/vr 4. / Ibs?ons/vr 5. Ibs/t'onstvr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: WHEN ROAD MATERIAL. "IS DEPLETED. <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: N/A