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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 -? <br />Denver, Colorado 80203 COLORADO <br />D I V IS I ON OF <br />Phone: (303) 866-356' RECLAMATION <br />FAX: (303) 832-8106 CONSTRUCTION MA'T'ERIALS MINING <br />REGULAR (112) OPERATION - &- <br />RECLAMATION PER_!VllT APPLICATION FORM SAFETY <br />Bill Ritter, )r_ <br />Governor <br />CHECK ONE: ' r 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 operat'Tgald W, cattany <br />New Application. (Rule 1.4.5) Amendment Application (Rule 1.10) Division Director <br />Natural Resource Trustee <br />Conversion Application it '12n1e 1,111 <br />r' <br />Permit ## Li ?-AZC (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) complete 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. StabilityExhibit, 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 1 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 OPERA'T'ION INFORMA'1'ION <br />'T'ype or print clearly, in the space provided, ALT, information requested below. <br />Applicant/operator or company name (name to be used on permit): <br />1.1 Type of organization (corporation, partnership, etc.):??r` <br />2. Operation name (pit, mine or site name): <br />3. Permitted acreage (new or existing site): <br />3.1 Change in acreage (+•) <br />3.2 Total acreage in Permit area <br />E;2 -5 /2o,422 1i i W V A-5L Pr?' <br />4. Fees: <br />4.1 New Application <br />4.2 New Quarry Application. <br />4.4 A.n3endment Fee <br />4.5 Conversion to 11.2 operation. (set by statute) <br />5. Primary commoditie(s) to be mined:?rJ? <br />5.1 <br />Incidental commoditie(s) to be mined: 1, .,-Gi ro6v-lbs <br />5.3 Anticipated end use of incidental. commoditie(s) to be mined: ?p 2 S permitted acres <br />Ibs/Tonsiyr 4. _----_._-__._I______,__.__ihsi I'o» iya <br />5.2 Anticipated end use of primary commoditie(s) to be mined: <br />acres <br />acres <br />$2,696.00 application tee <br />$3,342.00 quarry application <br />$2.229,00 amendment fee <br />2.sfi96.4#ti_.. conversion fee <br />2 - - -'? - - lbs,, rons!yr <br />5_ r' lbs Tons/yr <br />Office of Office of <br />Mined Land Reclamation Denver • Grand Junction • Durango Active and Inactive Mines