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STATE OF COLORADO <br />DIVISION OF RECLAMATION, MINING AND SAFETY AM - oy <br />Department of Natural Resources <br />1313 Sherman St, Room 215 COLORADO <br />D e n v e r , Colorado 60203 CONSTRUCTION MATERIALS D I V I S I O N OF <br />Phone: (303) 666-3567 RIECLAMATION <br />FAX: (303) 832-6106 REGULAR (112) OPERATION MINING <br />RECLAMATION PERMIT APPLICATION FORM SAFETY <br />Bill Rimer, Jr. <br />Governor <br />CHECK ONE: ?? There is a File Number Already Assigned to this Operation ? D <br />Pe M _79 142 - (Please reference the file number currently assigned to this operatioa)m&e Director <br />New Application (Rule 1.4.5) Amendment Application (Rule 1.10) Ronald W- ca"a"t' <br />Division Director <br />Conversion Application (Rule IA 1) Iarral Resource Tn"We <br />Permit # M - 79 -142 _ (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 signed 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 (Geotechnical 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 />81/2" 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. Applicaut/overator or company name (name to be used on permitl: CDOT <br />1.1 Type of organization (corporation, partnership, etc.). Government Agency - State of Colorado <br />2. Operation name (pit, mine or site name): BLM Pit - West of Maybell <br />3. Permitted scree a (new or eavstine site): <br />3.1 Change in acreage (+) <br />3.2 Total acreage in Permit area <br />24.62 permitted acres <br />39.50 acres .? <br />14.88 acres <br />4. Fees: <br />4.1 <br />New Application <br />$2.696.00 <br />application fee <br />4.2 New Quarry Application $3342.00 quarry application <br />4.4 Amendment Fee $2.229.00 amendment fee <br />4.5 Conversion to 112 operation (set by statute) $2,696.00 conversion fee <br />5. Primary commoditie(s) to be mined: Gravel <br />5.1 Incidental commoditie(s) to be mined: 1. - lbs/Tons/vr 2. / lbs/Tons/vr <br />3. 1 lbs/Tons/vr 4. / lbs/Tons/vr 5. / lbslTons/yr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: Road Construction <br />5.3 Anticipated end use of incidental commoditie(s) to be mined N/A <br />Office of Office of <br />Mined Land Reclamation Deriver • Grand )unction • Durango Active and Inactive Mines <br />