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AMA/ <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 <br />1."e- -?- s-'?' <br />CONSTRUCTION MATERIALS <br />Bill Ritter, Jr. <br />LIMITED IMPACT (110) OPERATION Governor <br />Harris D. Sherman <br />RECLAMATION PERMIT APPLICATION FORM Executive Director <br />Ronald W. Cattany <br />Division Director <br />CHECK ONE: There is a File Number Already Assigned to this Operation Natural Resource Trustee <br />Permit # M (Please reference the umber currently assigned to this operation) <br />New Application (Rule 1.4.5) Amendment Application (Rule 1.10) <br />Conversion Application (Rule 1.11) <br />Permit # M - 1126- o!;o (provide for Amendments and Conversions of existing permits) <br />The application for a Construction 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, Exhibit L, Addendum 1, and appropriate sections of 6.5 (Geotechnical Stability Exhibit), as required, and a check for <br />the application fee 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, ALL information described below. <br />2. <br />Applicant/operator or company name (name to be used on permit). _ <br />1.1 Type of organization (corporation, partnership, etc.): C':? '+r <br />Operation name (pit, mine or site name): L r, I c-r-. .-'cam ,,r- <br />3. Permitted acreage (new or existing site): <br />3.1 Change in acreage (+) <br />3.2 Total Acreage in Permit Area <br />4. Fees: <br />4.1 New Application: <br />Amendment Fee (C.R.S. 34-32.5-125(II)): <br />4.2 Conversion Fee (from 110d to 110 2$ ,696.00 conversion 9fee (Rule 1.11.2(2)) <br />5. Primary commoditie(s) to be mined: S?ti? Gn??"""' <br />5.1 Incidental commoditie(s) to be mined: 1.?ryK/ lbs o <br />4. / lbs/Tons/vr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: <br />Anticipated end use of incidental commoditie(s) to be mined: <br />G r <br />G Ci C-A- ?C- 1 <br />/_ 0 3 permitted acres <br />acres <br />(! S acres <br />$1,258.00 application fee <br />827.00 application fee <br /> <br /> <br /> <br />Division o, <br />(l? <br /> <br />ak.\X1• <br /> <br />25A/ lbs.Al?on?1'vr 3. / lbs/Tons/vr <br />5. / lbs/To s/ <br />Q--wS I ')? , <br />P'dad ?C°'S-Q, <br />m ?7A Vim' <br />COLORADO <br />D <br />• ?n IVISION OF <br />SCP ? ?,??? RECLAMATION <br />MINING <br />-&- <br />?;?ry ? _' .._• _... SAFETY <br />Office of Office of <br />Mined Land Reclamation Denver • Grand Junction • Durango Active and Inactive Mines