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STATE OF COLORADO <br />DIVISION OF RECLAMATION, MINING AND SAFETY <br />Department of Natural Resources O <br />1313 Sherman 5t., Room 215 <br />RECOD <br />Denver, Colorado 80203 <br />Phone: (303) 866-3567 <br />FAX: (303) 832-8106 ? MAR 0 6 2000 <br /> <br /> Division of Reclamation, <br /> CONSTRUCTION MATERIALS Mining and Safety <br /> LIMITED IMPACT (110) OPERATION <br /> RECLAMATION PERMIT APPLICATION FORM <br />COLORADO <br />D I V I S i O N O F <br />RECLAMATION <br />MINING <br />SAFETY <br />Hill Ritter, Jr. <br />Governor <br />Harris D. Sherman <br />Executive Dire.ctor <br />Ronald W. Cattany <br />Division Director <br />CHECK ONI : X /there is a File Number Already Assigned to this Operation Natural Resource Trustee <br />Permit W /M :1980- 049 (Please reference the file number currently assigned to this operation) <br />New Application (Rule 1.4.5) X Amendment Application (Rule 1.10) <br />Conversion Application (Rule 1.11) <br />Permit # __ M (provide for Amendments and Conversions of existing permits) <br />The application for a Constniction Materials Limited Impact (110) Operation Reclamation Permit contains three major parts: (1) the <br />application form; (2) Exhibits A-J, Exhibit L, Addendum 1, any sections of Exhibit 6.5 and Geotechnical Stability Exhibit, as required <br />by the Office, and outlined in Rules 6.1, 6.2, 6.3, 6.5, and 1.6.2(1)(b); and (3) the application fee. When you submit your application, be <br />sure to include one (1) complete signed and notarized ORIGINAL and one (1) copy of the completed application form, two (2) copies <br />of Exhibits A-J, lix.hibit L, Addendum. 1, and appropriate sections of 6.5 (Geotechnical Stability Exhibit), as required, and a check for <br />the application tee described under (4) below. Exhibits should NOT be bound or in a 3-ring binder; maps should be folded to 8 1/2"X <br />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, ALI, information described below. <br />ADWicant/operator or comoanv name (name to be used on nermit): <br />1.1 Type of organization (corporation, partnership, etc.): <br />2. Operation name (oit, mine or site name): Mott Pit <br />3. Permitted acreage (new or existing site : <br />3.1 Change in acreage (-+•) <br />3.2 Total Acreage in Permit Area <br />4. Dees: <br />4.1 <br />4.2 <br />Donald R. Hart <br />.-5.41 permitted acres <br />4 . 3 3 acres <br />9.74 acres <br />New Application., <br />Amendtr(rnt Fee (C:'.R.S. 34-32.5-125(11)): <br />C:"onversion. Fee ((corn 110d to 110 $1.1258.00 conversion fee. (Mule 1.1 1.2(2)} <br />5. Primary, commoditie(s) to be mined: Gravel <br />5.1 Incidental commoditie(s) to be rnined:TiPsoi11671 ;frbsiTislyr <br />4. .......... _%____. _Ihs%Tons/yr <br />5.2 Anticipated end use ofpritnarv commoditic(S) to be tn.i.ned: <br />;Anticipated end use of incidental co mnoditie(s) to be mined: <br />$1,258.00 applica.#ion fee <br />5$2'7.00 application (ec. <br />2. °vs P74 0yslTons/,yr 3. Ibs "Ions/ r <br />Road Base and Asphalt <br />Reclamation <br />Office of Office of <br />Mined Land Reclamation Deriver • Grand Junction • Durango Active and inactive Mines