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<br />STATE
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<br />CLCJRADD
<br />F
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<br />DIVISION OF'REC AMATiON,MINING,AND SAFETY
<br />Department of,Natuial Resources
<br />t 3 t 3 Sherman St._Room 215
<br />Denver, Colorado 60203 r a ?p?ry
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<br />C O L,O RA,D O
<br />D t v i s t o x. ,0 f
<br />Phone: (3031866235
<br />0 RECLAMATION
<br />FAXi(30318328106 MINING
<br /> .
<br /> ;SA FETY
<br />tt? "
<br />CONSTRUCTION' MATERIALS
<br />Bill Rmer; Jr.
<br />Governor
<br />LIMITED IMPACT (110) OPERATION.°'
<br />"
<br />Harris D She,
<br />RECLAMATION PERMIT APPLICATION FORM Ezecutrve
<br />We Ronald W:tlc Q Y
<br /> Division Director
<br />CHECK ONE; There is a File Number Already Assigried to this Operation Natural Resource Trustee,
<br />
<br />(Please reference the umber currently assigned to this operation) '
<br />Permit #. M 050
<br /> New Application (Rule.l,.4.5) Amendment Application (Rule 1:10)
<br /> Conversion Application -Rule 1 11
<br />as9s 050..
<br />Pernut . M - - (provide fo`r Amerldmerits and Conversions of extsting', permits),
<br />The application fora Constriiction Materials Limited Impact (14 0) Operation Reclamation Permit contains thtee'malor pans (1) the
<br />Exhibit; as required
<br />application form;(2) E'zhibits A J, Exhibit L, Addendum l; any sections of ExSu rt 6 S and '
<br />W h
<br />by the Office, and outlined in Rules`6 1, 6.2, 6 3 6 `S, and l 6.2(])(b); and ( 3)tlie,applicat on fee: Wherry' itibnutyourapplication;be..
<br />sure to include one,(1)':eyytrr, W6 si6' ea,and notarized ORIGINAL ana one{l) copyof the completed application foim two'(2) copies';
<br />of Exhibits A=J, Exhibit L; Addendum.l, and appropriate sections of 6 S (Geotechmcal Stability' Exhibit}; as requiied and a'.check for.
<br />the apgl'ication.fee;dekribedunder(4)below Exlutiits'shouldNOTbe'boundorina'3-rihgbinder,maps ,shouldbe,foldedto8l/2'X'
<br />l F" or $ 1/2".'X.1'4" Size: i To expedite processing please provide the' i'46, iat on iii the.`forniaf and ordertUscribed in this form
<br />
<br />GENERAL. OPERATION, INFORMATION
<br />„,Type or.print clearly, m the space,provided;. ALL ':information described below
<br />1 APpIlCani/OAerat'Or o 'co i, ny name (natne t0 be'•Used on.tiernut} ? ?""S E ?,i1 /y r /<=,?af I?'1.j.`i '.•
<br />
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<br />Privat wnershl
<br />6-b
<br />l a Type of organization'(corporation parmershipetc)
<br />L9946 Sand'.and Gravel Pit
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<br />ame)
<br />2 Operation name (i)ii mine or site
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<br />9.03
<br />3 'Perttutied acresae'(new or'existini site )., pertnitfed acres'`'
<br />3.1 Change in acreage (+), , .10.25. ' ,ac..
<br />3.2 . Total Acreage m Pertnit Area acres'
<br />4. Fees: .
<br />4..1 -'New Application 1? .258.00 r,..,application fee .,
<br />Amendment:Fee (C:R.S 34-32:5 125(II)):. $827 00 application fee '..
<br />1 4.2 : ConversionFee(frorn' 110d toA 4t$j 4.00Iconversion-fee'(Rule 1.-11.2(2))` ,
<br />5. Primary cominoditte(l2 to be mined
<br />-77-777777
<br />'
<br />...
<br />onsYvr. / lbs/Toas/yr ,,
<br />5.1, Incidental;comnioditie(s) to be.mmed: ,1::50101 1b omgLyr 2. 50K/ lb
<br />;+
<br />4 / Ibs/Tons/vr 5. / lbs/Tons/yr,
<br />5.2 Anticipated end use ofpnmary commoditie(s) to be mined: ConstrUetidh. Matertal 'Rodd BaSe,'
<br />Anticipated end use of incidental commoditie(s) to'be.;mined:
<br />5
<br />Office of C#fice of
<br />Mined Land Redamat+on Denver.., Grand junction + Durango Active and.Inacttve Mines
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