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TOTE OF COLORADO <br />DIVISION OF MINERALS ceAND s GEOLOGY RECEIVED <br />Department of Natural Resources <br />1313 Sherman St., Room 215 p DIVISION OF <br />Denver, Colorado 80203 MAY 8 2??? <br />Phone: (303) 866.3567 CONSTRUCTION MATERIALS M I N E RA L S <br />FAX: (303) 832.8106 REGULAR (112) OPERATION & <br />Division of Minerals and Geolo p E O L O G Y <br />RECLAMATION PERMIT APPLICATION FORM R E C L A M A T 10 N <br />MINING-SAFETY <br />Bill Owens <br />Governs <br />CHECK ONE: There is a File Number Already Assigned to this Operation Greg rn Walther <br />Permit # -M--_L7-485 ._ (Please oet'erence the file number currently assigned to this operation) Executive Director <br />Michael P. Long <br />New Application (Rule 1.4.5) Amendment Application (Rule 1.10) Division Director <br />o- Conversion Application (Rule 1.11) <br />Permit # M - 77 - 485 - (provide for Amendments and Conversions of existing permits) <br />The application for a Construction Materials Regular 112 Operation Reclamation Permit contains three major pare: (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 gad notarized IVORY O GIN AL 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 NOT be bound or in a 3-ring binder, maps should be folded to <br />8 112" 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 described below. <br />1. Applicant/operator or company name (name to be used on Permit): <br />RACA COUNTY <br />1.1 Type of organization (corporation, partnership. etc.): GOVERNMENTAL ENTITY <br />1.2 I.R.S. Tax I.D_ No. or Social Security Number: R4-6OpO744 <br />2. Operation name (nit. a or site name): GRAVEL PIT NO. 8 <br />3. Permitted acreage (new or alstinp site): _4.1 _ permitted acres <br />3.1 Change in acreage (+) 155.9 acres <br />3.2 Total acreage in Permit area 160.0 acres <br />4. Fee <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. Primarv commoditie(s) to be mined: SAND GRAVEL <br />5.1 Incidental commoditie(s) to be mined: 1. / lbsfrga r 2. / IbslTons/vr 3. / Ibs/Tons?r <br />4. / Ibs/1 ons/vr S. ! ]bslTons/vr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: WHEN SAND /GRAVEL IS DEPLETED <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: N/A