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STATE OF C01 <br />;; M/ <br />.nRAT)C-) <br />DIVISION OF RECLAMATION, MINING AND SAFETY <br />Department of Natural Resources <br />1313 Sherman SL, Room 215 t fn Deriver, Colorado 80203 4. <br />Phones (303) 856.3567 <br />FAX: (303) 832.8106 N ?It I r <br />Qlvissicri 01' Kt::i:i:?? s <br />CONSTRUCTION MATERLAL;Snm9 and Saf-ty <br />LIMITED IMPACT (110) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />CHECK ONE a There is a File Number Already Assigned to this Operation <br />COLORADO <br />DIVISION OP <br />RECLAMATION <br />MINING <br />SAFETY <br />Bill Ritter, Jr. <br />Governor <br />Harris D. Sherman <br />Executive Director <br />Ronald W. Cartany <br />Division Director <br />Natural Resource Trustee <br />Permit # M ?cos _ 047 _ (please reference the umber currently assi <br />fined to this operation) <br />New Application (Rule 1.4.5) `? Amendment Application (Rule 1.10) <br />Conversion Application (Rule 1.11) <br />Permit # M _ 2006 _ 047 _ (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 A4, 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 81/2" 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 />1. Applicant/operator or company name (name to be used 24 permit): _ K t { ZOL Y- SB n 0_0 ? <br />IA Type of organization (corporation, partnership, etc.): County Goyemment <br />2. Operation name (pit, mine or site name): <br />3. Permitted acreaEe (new or eisting site): <br />3.1 Change in acreage (+) <br />Klassen Pit <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(H)): <br />4.2 Conversion Fee (from 1 lod to 110 $2.696.00 conversion fee (Rule 1.11.2(2)) <br />5. Primary commoditie(s) to be mined: Gravel Sand Clay <br />_ 7.5 permitted acres <br />2.4 <br /> acres <br />9 <br />9 <br />. acres <br />$1,;58.00 application fee <br />827.00 application fee <br />5.1 Incidental commoditie(s) to be mined: 1. - / 1bslTons/?rr 2. lbs/Tons/vr 3. / lbs/Tons/vr <br />4. / Ibs/fons/vr 5. / lbs/Tons/?r <br />5.2 Anticipated end use of primary commoditie(s) to be mined: Road material <br />Anticipated end use of incidental commoditie(s) to be mined: Road material <br />Office of <br />ti <br />Mined Land Reclamation Office <br />Deriver ' Grand Junction ' Durango Active and Inactive Mutes