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lI1?IN91AIIN <br />999 <br />orl. STATE tCOLOMDO <br />DIVISION OF MINERALS AND GEOLOGY <br />17o1),lrrmcnl of Natural Resources <br />HI 3 $hcrman St.. Ruom 215 <br />Dcnvcr, Colorado 80203 <br />Phone: 110 11 86h-3567 <br />FAX: t 1031 832.8106 <br />CONSTRUCTION MATERIALS <br />REGULAR (112) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />I <br />PW. <br />DEPARTMENT OF <br />NATURAL <br />RESOURCES <br />Roy Romer <br />Governor <br />Wmes S. Lochhead <br />Executive DneCtor <br />Michael 8. Long <br />Oiviston Director <br />CHECK ONE: New Application (Rule 1.4.5) Amendment Application (Rule 1.10) <br />._ Conversion Application (Rule 1.11) <br />Permit 4 -&_- 23 - 087 - (provide for Amendments and Conversions of <br />existing permits) <br />The application for a Construction Materials Regular 112 Operacion Reclamation Permit contains <br />three major pares: (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) co lete signed and notarized IVORY ORIGINAL and four (4) <br />copies of the completed Ivor 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 />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, ALL information requested below. <br />1. Applicant/operator or company name (name to be used on 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 (pit, mine or site name): WEEDEN LAND & CATTLE CO. PIT NO. 30 <br />3. Permitted acreage (new or existing site): 9.9 permitted acres <br /> 3.1 Change in acreage (+) 150.1 acres <br /> 3.2 Total acreage in Permit area 160.0 acres <br />4. Fees: <br /> 4.1 New Application __51,875.00 application fee <br /> 4.2 New Quarry Application S2,325.00 quarry application <br /> 4.3 Milling Application (Non-DMO) S3,100.00 milling application <br /> 4.4 Amendment Fee 51,550.00 amendment wee <br /> 4.5 Conversion to 112 operation (set by statute) _ <br />51,875.00 conversion fee <br />5. Primar y commoditie(s) to be mined: GRAVEL <br /> 5.1 Incidental commoditie(s) to be mined: 1. lbs/Tons/v= <br /> 2. i lbs/Tons/vr 3. / lbs/Tons/vr <br /> 4. i lbs/Tons/vr S. / 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 of incidental commoditie(s) co be mined: