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STATE OF COLORADO <br />DWBION CW UaAMATM, M04NG AND SAFETY <br />DgWbrecaai'NWAW Resources <br />1313U 5t, Room 213 <br /> <br />nver.Coloradosam <br />De COLD1tADO <br />Phorm poi 86 s a w CONbKJKU I O N MeTERrAT Q D I V I S I O N of <br />RECLAMATION <br />FAX: OM ti3 M06 REGULAR(113)OPERATION MINING <br />RECLAMATION PERMIT APPLICATION FORM SAFE'- <br />04 v smPAM Jr. <br />CRECK ONE: I la There is a 0 Number Alxeulf r esdgncd to this op &dun clWAMW <br />P 205 = - (Please nfimw ft file aumbea auteatiy assigned to tbds Decor <br />New Application (Ruler 1.4.5) AmendmentApptication (Rule 1.10) "WCOW <br />HC6nvudffWApPU=donM* ldl) NOW ResouMTrudw <br />M-2005-006 <br />pan* # , M- &ovide for Amendmcmb and Conventons of as d mg perms) <br />The application for a Comehrnction Materials Regular 112 Opawfioa Reclamation Permit contains throe major garter (1) the application <br />form; (2) E xbA is AA Addeodmn 1, any sections of Exhrloat 6-5 (Geotechnical Stabiht' yExbib% and (3) the applicationfw. When you <br />submit your application, be sure tD inciode one (1) complete dined Ed a jUdWA ORIGIlfTAL and one (1) copy of the completed <br />appiia?dmfb ra, two (2) copies ofExhibits A-S, Addmdam 1, appropriate wcdm of6.5 (Geotechni d SWulit yExWt, andache* for <br />the application fee deacn3ed under Secadon (4) below. Exhibits dwuld,NOT be bawd or is a 3-ring bind, maps should be folded to <br />81/2" X 11" err 81/2" X 14" sizes To expedite processiug,please provide do mtmmsdonindie formst and order desrar'bed in this form. <br />GENERAL OPERATION DMRMATMN <br />Type or print clearly, is the space provided, ALL information requested below. <br />1. A ean#oaeratmror comoasi9nsme (mum to be used onaer=: Lounly L OMMiS s 3.0ners <br />1.1 Tylo of (copmwion, partnership, etc.): Local Government <br />2. Onerattonnamelaft.mtaeors[tensme): Powderwash Pit No. 66. <br />3. PermttW screare (new or edEft dta- <br />3.1 Chamge in acreage (+) <br />3.2 Total acreage inPermit area <br />4. &es <br />4.1 New Application <br />42 New QuairyApplicatiicn <br />4.4 Amy Fee <br />4-5 C onto 112 operation(set by statute) <br />30.85 permitted acres <br />+ 0.18 acres <br />31.03 acres <br />W6 - 00 application free <br />4 quarry application <br />XXX SZ.229 00 amt fee <br />X00 conversion foe <br />S. Zdaa g&t,be mmbm&. Gravel Sand C1ay <br />5.1 Incidental oommodWs) to be mined: 1. X/A - Db91999a 2. / lbs/Pons/vr <br />3.- / Ibsrl'ons/vr 4. j Ibs/TQy! S. - / 16slPons/vt <br />5.2 A dcipatedenduseofprWmycmodkWs)wbemiwd: Road Construction Materials <br />5.3 Aw3 end.use ofhid&md commoditie(s) to be mined: N/'A <br />Adned U 3 LUUZI bvvcd ftof <br />nation Denver ' Gand an " DAoaW Acbmand hiactim Mines <br />C11 NR GRANS dOi)InS;ON OF D OFFICE <br />RECLAMAMON MINING & SAFETY