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lllllllpl <br />? STATE MF COLUI lgltl999 <br />DIVISION OF MINERALS AND GEOLOGY <br />Sit-partmmnt of Natural Resources <br />1313 Sherman St., Room 215 <br />f hemtiv. Colnra(lo 80 203 <br />Phone I U) 1) 86h-3567 <br />FAX: I St) 11 832-810b <br />RECEIVED <br />RECEIVED <br />007-1 <br />DEPARTMENT OF <br />NATURAL <br />RESOURCES <br />Roy Romer <br />Governor <br />lames S. tochhead <br />Executive Director <br />Michael B. Long <br />Division Director <br />SEP 1.0 2001 <br />AUG 2 ; 2001 <br />Division of Minerva and Geology <br />Division of Minerals and Geology <br />CONSTRUCTION MATERIALS <br />REGULAR (112) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />CHECK ONE: New Application (Rule 1.4.5) Amendment Application (Rule 1.10) <br />X Conversion Application (Rule 1.11) <br />Permit d 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 />---- AF <br />OPERATION INFORMATION <br />Type or print clearly, in the space provided, ALL information requested below. <br />1. Applicant/overator or camp name (name to be used on vermit): <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 (Rit, mine or site name)- WALSH PIT NO. 2 <br />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 $1,875.00 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 $1,550.00 amendment fee <br />4.5 Conversion to 112 operation (set by statute) ?S1,875.00 conversion fee <br />5. PrimaxX commoditie(s) to be mined: GRAVEL <br />5.1 incidental commoditie(s) to be mined: 1. lbs/Tons/vr <br />2. / lbs/Tons/yr 3. / lbs/Tons/vr <br />4. i lbs/Tons/vr 5. / lbs/Tons/vr <br />5.2 Anticipated end use of primary commoditie(s) to be mined:UNTIL GRAVEL IS DE LETED <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: