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s <br />M- ;2010 - 0 7Z;' <br />STATE OF COLORADO <br />DIVISION OF RECLAMATION, MINING AND SAFETY <br />Department of Natural Resources <br />"CWV1W <br />1313 Sherman SL, Room 215 C O L D RA D O <br />Denver, Colorado 80203 <br />Phone: (303) 866.3567 <br />V 1 8 201 o <br />i DIVISION OF <br />RECLAMATION <br />I <br />G <br />I\U <br />FAX: (303) 8328106 tJ MIN <br />N <br />©WWWR of paean, SAFETY <br />Nifte and )Maly <br />CONSTRUCTION MATERIALS Bill Ritter, Jr. <br /> <br />LIMITED IMPACT (110) OPERATION Governor <br /> Hams D. Sherman <br />RECLAMATION PERMIT APPLICATION FORM Executive Director <br /> Ronald W. Cattany <br /> Division Director <br /> <br />CHECK ONE: There is a File Number Already Assigned to this Operation Natural Resource Trustee <br />Permit # M -- -_ (Please reference the fil number currently assigned to this operation) <br />? New Application (Rule 1.4.5) FL L Amendment Application (Rule 1.10) <br />Conversion Application (Rule 1.11 <br />) <br />Permit # M - - (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 />Applicant/operator or company name (name to be used on permit): <br />1.1 TvDe of organization (corporation, partnership, etc.): County Govemment <br />2. Operation name (pit, mine or site name): <br />3. Permitted acreage (new or elastine site): <br />7Y Ranch Pit #1 <br />3.1 Change in acreage N <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$,696.00 conversion fee (Rule 1. 11.2(2)) <br />5. Primary commoditie(s) to be mined: Gravel Clay Sand _ <br />9.9 permitted acres <br />acres <br />9.9 acres <br />1 58.00 application fee <br />8$ 27.00 application fee <br />5.1 Incidental commoditie(s) to be mined: 1. ! lbs/Tons/vr 2. / lbs/Tons/vr 3. / lbs/Tons/vr <br />4. / lbs/Tons/vr 5. / lbs/Tons/vr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: Road construction <br />Anticipated end use of incidental commoditie(s) to be mined: Landscaping materialDo <br />Office of <br />Mined Land Reclamation <br />Deriver • Grand )unction • Durango <br />Office of <br />Active and Inactive Mines