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STATE OF COLORADO <br />DIVISION OF RECLAMATION, MINING AND SAFETY <br />Department of Natural Resources <br />1313 Sherman St., Room 215 C O L O R A D O <br />Denver, Colorado 80203 CONSTRUCTION MATERIALS DIVISION o F <br />Phone: (303) 866.3567 RECLAMATION <br />FAX: (303) 832 - 8106 REGULAR (112) OPERATION MINING <br />RECLAMATION PERMIT APPLICATION FORM SAFETY <br />Bill Ritter, Jr. <br />CHECK ONE ❑ There is a File Number Already Assigned to this Operation Governor <br />Harris D. Sherman <br />P eff M (Please reference the file number currently assigned to this operatiox)ecutive Director <br />New Application (Rule 1.4.5) Amendment Application (Rule 1.10) Ronald W. Cattany <br />� Division Director <br />1- Conversion Application (Rule 1.11) Natural Resource Trustee <br />Permit # M - 2005 0 60 - (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 />8 1/2" X 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 requested below. <br />1. App licantloverator or company name name to be used on perm Weld County Public Works <br />1.1 Type of organization (corporation, partnership, etc.): County government <br />2. Operation name (nit, mine or site name) Ashbaugh Pit Expansion <br />3. Permitted acreage (new or existing site) 1 0 permitted acres <br />3.1 Change in acreage ( +) 1 - .7 acres <br />3.2 Total acreage in Permit area 1 39.7 acres <br />4. Fees <br />4.1 <br />New Application <br />$2,696.00 <br />application fee <br />4.2 <br />New Quarry Application <br />$3,342.00 _ <br />quarry application <br />4.4 <br />Amendment Fee <br />$2,229.00 <br />amendment fee <br />4.5 <br />Conversion to 112 operation (set by statute) <br />$2,696.00 <br />conversion fee <br />5. Primary commoditie(s) to be mined Gravel Sand <br />Clay <br />5.1 <br />Incidental commoditie(s) to be mined: 1. - <br />lbs/Tons /yr 2. / <br />lbs /Tons /yr <br />3. / lbs/Tons /yr 4. / <br />lbs/Tons /yr 5. / <br />lbs/Tons /w <br />5.2 <br />Anticipated end use of primary commoditie(s) to be mined: <br />County road maintenance and construction <br />5.3 <br />Anticipated end use of incidental commoditie(s) to be mined: <br />Office of Office of <br />Mined Land Reclamation Denver • Grand Junction • Durango Active and Inactive Mines <br />