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<br />DIVISION OF MINERALS AND GEOLOGY <br />nr•parlnu-ni of Natural Resources <br />1 f 13 5ht•rman St., Rowan 215 <br />lknvt-r. Culnradu M203 <br />Phone 111) 1) 86b-3567 <br />FAX: 1 11) It 832.810b <br />STATE MF COLt"Itl1u1pNd19 <br />RECEIVED <br />SEP 1.0 2001 <br />RECEIVED <br />AUG 2 : 2001 <br />DEPARTMENT OF <br />NATURAL <br />RESOURCES <br />Division of MhWals and Geolm <br />Division of Minerals and Geology <br />CONSTRUCTION MATERIALS <br />REGULAR (112) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />Roy Romer <br />Governor <br />James S. Lochhead <br />Executive Director <br />Michael a. Long <br />Division Director <br />CHFrCK ONE: Now Application (Rule 1.4.5) Amendment Application (Rule 1.10) <br />X Conversion Application (Rule 1.11) <br />Permit # 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 />6 'E '00 <br />=1 7 %9W <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, ALL information requested below. <br />1. Applicant/operator or comvanv name (name to be used an 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 (tit, mine or site name): WALSH PIT N0, 2 <br />?3 Permitted acreage (new or existing site): 5.2 permitted acres <br />3.1 Change in acreage (+) 74,8 acres <br />3.2 Total acreage in Permit area 80.0 acres <br />4. Fees. <br />4.1 New Application 51,875.00 application fee <br />4.2 New Quarry Application ,$2,325.00 quarry application <br />4.3 Milling Application (Non-DMO) $3,100.00 milling application <br />4.4 Amendment Fee 51,550.00 amendment fee <br />4.5 Conversion to 112 operation (set by statute) $1,875.00 conversion fee <br />5. Primary commoditie(s) to be mined: GRAVEL <br />5.1 Incidental co=oditie(s) to be mined: 1. lbs/Tons/vr <br />2. / lbs/Tons/yr 3. / lbs/Tons/vr <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 o-f incidental commoditie(s) to be mined: