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<br />JUN 2'1 J0 <br />@iaision of ivi"101als ?, :, olefryy <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 -Y1 ---(1-2- -_ (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 - - - (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 <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-ring binder; maps should be folded to <br />8 1/2" X l 1" 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 />4%3 <br />Applicant/operator or company name (name to be used on permit): <br />1.1 Type of organization (corporation, partnership, etc.): <br />2. Operation name (pit, mine or site name): i l d o r_s <br />3. Permitted acreaee (new or existing site): t? permitted acres <br />3.1 Change in acreage (+) ® acres <br />3.2 Total acreage in Permit area 910 acres <br />4. Fees: <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 $1,938.00 amendment fee <br />4.5 Conversion to 112 operation (set by statute) $2.344.00 conversion fee <br />5. Primary commoditie(s) to be mined:' V <br />5.1 Incidental commoditie(s) to be mined: 1. - Ibs/Tons/yr 2. / Ibs/Tons/yr <br />3_ ! Ibs/Tons/yr 4. / lbs/Tons/vr ??tt5. / ibs/Tons/yr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: ??%P.?a Q rf(?2 / (n n Ski ?? [.?i?Y1 f trl7 ?'!C ?Pi( . <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: