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<br />? BIINItlIpgNIN <br />HATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />Department of Natural Resources <br />1313 Sherman St.. Room 215 <br />Denver. Co)orado 80203 <br />RFC <br />A'-? <br />Phone: (303) 866-3567 CONSTRUCTION MATERIALS ? <br />FAX: (3031832 8106 REGULAR (1112) OPERATION A?LL ??J? ?? <br />RECLAMATION PERMIT APPLICATIOIV'?jgRM I B <br />4 p??1r'Bra 1 <br />?ta'?Ceo/ <br />gHECK ONE: There is a File Number Already Assigned to this Operation eg1' <br />Permit # M - 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 existing permits) <br />DIVISION 0 <br />MINERALS <br />GEOLOGY <br />.RECLAMATION <br />MINING•SAFETY <br />Bill Owens <br />Governor <br />Greg E. Watcher <br />Executive Oirecror <br />Michael9 Long <br />Owrsion Oireaor <br />The application for a Construction Materials Regular 112 Operation Reclatnatioa 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) complete signed sad notarized IVORY ORIGINAL 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 (Geotechnical Stability Exhibit, and a check for <br />the application fee described under Section (4) below. Exhibits should M 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 form. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, to the space provided, all information described below. <br />AVDU"nt/ooerator or nMoany panne jpame to be used" permit): <br />BACA COUNTY <br />1.1 Type of organization (corporation, partnership, etc.): GOVERNMENTAL ENTITY/ROAD St BRIDGE DISTRICT III <br />1.2 I.R.S. Tax I.D. No. or Social Security Number. 84-6000744 <br />QQec?vv is <br />2. Operation name (pit, mine or sJite aame): MCVEY PIT -L?it3:- +6 <br />3. Perm itted acreatte (new or etl11athta site): 8.57 permitted acres <br />3.1 Change in acreage (+) 1_51-41 acres <br />3.2 Total acreage in Permit area 160.00 acres <br />4. Fe--Ie : <br />4.1 New Application $2,344.00 application fee <br />4.2 New Quarry Application $2,906,00 quarry application <br />4.4 Amendment Fee 11.938.00 amendment fee <br />4.5 Conversion to 112 operation (set by statute) 52.344.00 conversion fee <br />5. Primarv c mmodidefs) to be mined: SAND GRAVEL <br />5.1 Incidental commoditie(s) to be mined: 1. ! lbs/Toaslvr 2. 1 )bs/To ah,r 3. / Ibs/Tons/vr <br /> 4. ! IbsffonshT 5. 1 Ibsgons/vr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: UP LY IS DEPLETED <br />5.3 Anticipated end use of incidental commoditiee(s) to be mined: N/A