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STATE OF COLORADO <br />DIVISION OF RECLAMATION, MINING AND SAFETY <br />Department of Natural Resources <br />1313 Sherman St., Room 215 0 0 I- Q (o COLORADO <br />Denver, Colorado 80203 /4 - D / o I v I S ION o f <br />Phone: (303) 866-3567 RECLAMATION <br />FAX: (303) 832-8106 CONSTRUCTION MATERIALS MINING <br />REGULAR (112) OPERATION SAFETY <br />RECLAMATION PERMIT APPLICATION FORM <br />Bill Ritter, Jr. <br />Governor <br />CHECK ONE: There is a File Number Already Assigned to this Operation Harris D. Sherman <br />Executive Director <br />Permit # M (Please reference the file number currently assigned to this operati91aald w. Cattany <br />XXX New Application Rule 1.4.5) Amendment Application (Rule L I0) D""" Director <br />( Natural Resource Trustee <br />Conversion Application (Rule L 11) <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) Exlu`bits 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) complete signed and notarized ORIGINAL and one (1) copy of the completed <br />application form, two (2) copies of Exhibits A-S, Addendum I, appropriate sections of 6.5 (Geotechnical Stability Exhibit, and a check for <br />the application fee described tinder Section (4) below. Exhibits should NOT be bound or in a 3-ring binder; maps should be folded to <br />8 1/2" X I I " 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 />'T'ype or print clearly, in the space provided, ALL information requested below. <br />Moffat County Board of <br />I. Applicant/operator or company name (name to be used on permit): County Commissioners <br />1.1 Type of organization (corporation, partnership, etc.): Local Government <br />2. Operation name (pit mine or site name): Clay Pit No. 21 <br />3. Permitted acreage (new or existine site): <br />3.1 Change in acreage (+) <br />31 Total acreage in Permit area <br />4. Fees: <br />4.1 New Application <br />4.2 New Quarry Application. <br />4.4 Amendment Fee <br />4.5 Conversion to It 2 operation. (set by statute) <br />5. <br />Primarv eontntoditicts) to be mined: Clay <br />18.498 <br />0? <br />18.498 <br />permitted acres <br />acres <br />acres <br />XXXXX $2,696.00 application fee <br />_11,3 42.00 quarry application <br />$2.229.00. amendment fee <br />$2.696.00_.. conversion fee <br />1_bsfrons%yr 2. _ thslTonsfvr <br />5.1 Incidental commoditie(s) to be mined: I. N/A <br />-r 5. lbslTon <br />3. i lbs/Tonsivr 4. lbs!Tonsly <br />5.2 Anticipated end use of primary commoditie(s) to be mined: Road Construction Materials <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: N/A <br />- Office of <br />Mined Land Reclamation <br />Denver • Grand junction • Durango <br />Office of <br />Active and inactive Mines