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ECEIVED <br />CONSTRUCTION MATERIALS SEP 2 9 2004 <br />• REGULAR (112) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM ?Division of Mineratsand Gee199Y <br />CHECK ONE: $- There is a File Number Already Assigned to this Operation <br />Permit # M -Itliq-10- (Please reference the file number currently assigned to this operationn)) <br />New Application (Rule 1.4.5) Amendment Application (Rule 1.10) ? <br />Conversion Application (Rule 1.11) i~ 1 !, i -- `4? <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) pom le?gned 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 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 inforrmationn requested below. <br />1. Applicant/operator or company name (name to be used on permit): L- <br />1.1 Type of organization (corporation, partnership, etc.): (P?Tt Crn1 <br />1.2 I.R.S. Tax I.D. No. or Social Security Number: !V (p ` 022-` &0i <br />2. Operation name (pit, mine or site name): R&T L%J f (W_- ' *-b q l'j ?AV -- ti`G v <br /> <br />3. Permitted acreage (new or eaistine site permitted acres <br />3.1 Change in acreage (+) acres <br />3.2 Total acreage in Permit area Z2 7 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 commoditio(s) to be mined: <br />5.1 Incidental commoditie(s) to be mined: 1. - ibs/Tongyr 2. / Ibs/Tona(y <br /> 3. / Ibs/Tons/v 4. / Ibs/Tongy 5. / Ibs/Tons/yr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: Ud `o _, A a <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: I l " U <br />