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<br />STATE OF COLORADO <br />DIVISION OF RECLAMATION, MINING AND SAFETY <br />Department of Natural Resources <br />1313 Sherman St., Room 215 <br />Denver, Colorado 80203 <br />Phone: (303) 866-3567 <br />FAX: (303) 832-8106 CONSTRUCTION 14IATERIALS <br />REGULAR (112) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />q.. I r <br />COLORADO <br />D IV IS I ON Of <br />RECLAMATION <br />MINING <br />SAFETY <br />Bill Ritter, Jr. <br />Govemor <br />CHECK ONE: There is a File Number Already Assigned to this Operation Harris D. Sherman <br />Executive Director <br />Permit it M - - (Please reference the file number currently assigned to this operat'Tg ald w. Cattany <br />New Application (Rule 1.4.5) Amendment Application (Rule 1.10) Division Director <br />Natural Resource Trustre <br />Conversion Application (Rule 1.11) <br />Permit # _ M . L9 `11e 08(a (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) cotnplete signed 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 />8 112" X 11" or 8 12 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 requested below. <br />Applicant/operator or company name (name to be used on permit): C's e /, /Y1 <br />1.1 Type of organization (corporation, partnership, etc.): (! ci r a?_?_?r >.I__ D s20- 8 -'S Yd YO <br />.2. Operation name (pit, mine or site name): k ? C/ l-"? E 5, <br />3. Permitted acreat=e (new or existing site): <br />3.1 Change in acreage (+ } <br />3.2 `rota( acreage in Permit area <br />4. Fees: <br />4.1 New Application T ? . <br />4.2 New Quarry Application. <br />4.4 Amendment Fee <br />4 5 Conversion. to 112 operation (:set by statute) <br />5. Primary commoditie(s) to be mined: 5 e- 1? d C7 "I V ? <br />5.1 Incidental commoditie(s) to he mined: l:._...___..._........__..-...___......_.__...lbs,, l_onshr <br />3.lbsjons yr 4 <br />5.2 Anticipated end use of primary commoditie(s) to be j <br />`?U6 <br />5.3 Anticipated end use of incidental commoditie(s) to y Ni(t)i 1VIV I J <br />L 1° -01 V 91 b" L?OZ <br />S permitted acres <br />acres <br />acres <br />$2,696.00 application fee <br />$3,342.00 quarry application <br />52,229.00 amendment fee <br />52,696.00 conversion fee <br />ibs/ fons%vr <br />2. - - _.. - = --- - - .._.....-_.t._ <br />5' - _ tbs"fonsyr <br />Office of U_=,1X1 t Office of <br />Mined Land Reclamation Denver • Grand junction • Durango Act ve and Inactive Mines