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N\, c <br />STATE OF EC97M <br />-( DtVMONOF RCLAMATION, AUNINGAND SAWf RECEIVED <br />Deparvnent of Natural Resourons i? <br />1313 Sherman St, Roam 215 <br />Demrer,Colorado 80203 ?f*#N 2 A11 13 2011 <br />Phone (303) 666-3567 2011 GRAND J1ArC' f icy; i <br />FAX: (303)t) 41106 Fi1D OFFICE <br />A at A00WONAW" DIVISION ?JF <br />L6111 i4 and SO* RECLAMATION MINI dG d SAFETY <br />CONSTRUCTION MATERIALS <br />Uaff ED IMPACT (110) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />CECK, ONE: Q There is a File Number Already Assigned to this Operation- <br />COLORADO <br />DIVISION O! <br />RECLAMATION <br />MINING <br />SAFETY <br />aili gnW, i.. <br />Ciov"TOr <br />Mavis D. Sherman <br />6xeeuave ohedw <br />Ronald w. cmm <br />Division Dhicbr <br />Natural RaourosTmov <br />Permit # M _ (Please reference the currently assigned to this operation) <br />New Application (Rule I A.5) Amendment Application (Rule 1.10). <br />Conversion Application (Rule 1.11) <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 foam; (2) Exhibits A-J, Exhibit L, Addendum 1, any sections of Exhibit 6.5 and Geotecbn cal 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 siBneii and notarized ORIGINAL and one (1) copy of the completed application form; two (2) copies <br />of Exhibits A-J, Exhibit I., 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 />1 I" 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 described below. <br />1. Appliicaut/oomtor or company name (name to be used on permit): 'C d M <br />1.1 Type of organization (corporation, partnership, etc.): Limited Liability Company <br />2. Operation name (pit, mine or site name): Lost Cause Pond <br />3. Permitted acrease (new or existing site): 9.9 permitted acres <br />3.1 Change in acreage (+) acres <br />3.2 Total Acreage in Permit Area 9.9 acres <br />4. Pees: <br />4.1 New Application: $1,258.00 application fee <br />Amendment Fee (C.R.S. 34-32.5-125(II)): S827.00 application fee <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: Silt material from water run-off <br />5.1 Incidental commoditie(s) to be mined: 1. / IbarTons/yr 2. / 1bslToils/vr 3. / lbs/Tans/vr <br />4. / Ibs(Ions/yr 5. / lbslfonsl? <br />5.2 Anticipated end use of primary commoditie(s) to be mined: Construction material / fill dirt <br />Anticipated end use of incidental commoditie(s) to be mined: n / a <br />officeof Office Of <br />Mined Land Re mnation Denver • Grand Junction 9 Durango Active and Inactive Mines <br /> <br /> <br />