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09/29/2007 SAT 9:37 FAX 720 977 6201 CITY OF THORNTON-INFRA <br />CONSTRUCTION MATERIALS <br />REGULAR (112) OPERATION <br />RECLAMATION PERMIT APPLICATION ]FORM <br />CHECK ONE There is a File Number Already Assigned to this Operation <br />Permit # M -107 -A-_ (please reference the file number currently assigned to this operation) <br />New Application (Rule 1.4.5) Amendment Application (Rule I.10) <br />-2C- Conversion Application (Rule 1.11) <br />Permit # M - - (provide for Amendments and Conversions of existing permits) <br />2004/010 <br />The application for a Construction Materials Regular 112 Operation Reclamation Permit contains three major parts; (1) the application <br />form; (2) Exhibits A-S, Addendum 1, any sections of Exhibit 6.5 (Geotechnical Stability Exhibit; and (3) the application fee. When you <br />submit your application, be sure to include one (1) complete signed and notarized ORIGINAL and one (1) copy of the completed <br />application form, two (2) 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 NOT be bound or in a 3-ting 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, in the space provided, ALL Information requested below. <br />1. A lfcagNa erator or c m an name n me to be used on ermit : J, R, 0 61 <br />f' r <br />1.1 Type of organization (corporation, partnership, etc.): <br />2. Operation name (pit, urine or j%tg game): P rte' o4 A rP q e.+ e- <br />, r.? • _ <br />3. Permitt aerea(new xisting e)_ c permitted acres <br />3.1 Change in acreage (+)'`!? acres <br />3.2 Total acreage in Permit area acres <br />4 Etcg. <br />4.1 New Application 52.344.QO application fee <br />4.2 New Quarry Application $2,906.00 quarry application <br />4.4 Amendment Fee S1.938.0o amendment fee <br />4.3 Conversion to 1] 2 operation (set by statute) $2,344.04 conversion fcc <br />5. Primary m ti s t mined <br />5.1 Incidental commoditie(s) to be mined- 1. - LbsrI onslvr 2. / lb?fl er,/yr <br />3_ / 1 Srfo s/ 4, / lbs//Torts/vr /r5. <br />5.2 Anticipated end use of primary conunoditic(s) to be mined: L+7 H orQ/. Carl 57r c? c1?':r9t 1 >/?d Yjf,? P ie ___ <br />5.3 Anticipated end use of incidental commoditie(s) to be mitred: