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<br />2. <br />?I oho no 9 <br /> STATE OF COLOWO <br />DIVISION OF RKLAMATION, MINING AND SAFETY <br />Depe?hneM of Na&AW Rmun m <br />1313 Sherman SL, Room 215 COLORADO <br />Colorado 80203 CONSTRUCTION MATERIALS DIVISION O F <br />RECLAMATION <br />Phone: 00318663567 <br />FAX: 0031832-8106 REGULAR (112) OPERATION MINING <br /> RECLAMATION PERMIT APPLICATION FORM SAFETY <br />Bill Rimer, jr. <br />GOMM" <br />CHECK ONE: El There I, a File Number Already Assigned to this Operation <br />Harris D. Shemmin <br />P M _ (Please reference the file number cunentiy assigned to this operahon)WOm- mecow <br />New Application (Rule 1.4.5) -DAm=dmem Application (Rule 1.10) RO W W. C=W <br />Division Dbecwor <br />Conversion Application (Rule 1:11) Natural Resource Trustee <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) 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 sinned 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 (Geoteclmical Stability Exhibit, 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 11" or 81/2" 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 requested below. <br />1. Amplicant/overator or company name (name to be used on permit): Jesse Stackhouse-Road Supervisor <br />1.1 Type of organization (corporation, partnership, etc.): County <br />Operation name (nit, mine or site name): State of Colorado Land Board Pit <br />5. Primary- commoditi s to be mined: sand gravel silt <br />5.1 Incidental commoditie(s) to be mined: 1. gravel_ 12800 lbs/Tons/vr <br />3. Permitted acreage (new or existina site): 40 permitted acres <br />3.1 Change in acreage N acres <br />3.2 Total acreage in Permit area 40 acres <br />4. Fees: <br />4.1 <br />New Application s? n <br />1 Lf <br />$2.696.00 application fee <br />4.2 New Quarry Application qty application <br />4.4 Amendment Fee <br />Reclamation, <br />®IVl3 m. amendment fee <br />4.5 Conversion to 112 operation (set by statute) hAlning <br />Saf ty conversion fee <br />3. / lbs/Tons/vr 4. / lbs/Tons/yr <br />Anticipated end use of primary commoditie(s) to be mined: Road Cover <br />5.3 Anticipated end use of incidental commoditie(s) to be mined:Road Construction <br />5.2 <br />Office of Office of <br />Mined WW Reclarnatim Denver • GraW Junction • Durango Active and Inactive Mines <br /> <br />silty clay <br />2. / lbs/Tons/vr <br />5. / Ibs/Tons/wr <br />1'