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0 <br />STATE OF COLORADO <br />DIVISION OF RECLAMATION, MINING AND SAFETY <br />Department of Neural Resoumes <br />1313 Shuman St., Room 21 S C O L O R A D O <br />Denver, Colorado 80203 <br />CONSTRUCTION MATERIALS D I V I S I O N Of <br />RECLAMATION <br />Phone: (303) 863567 <br />FAX: (303) 832.8106 REGULAR (112) OPERATION MINING <br />RECLAMATION PERMIT APPLICATION FORM SAFETY <br /> Bill RAW, Jr. <br />CHECK ONE: ? There Is a File Number Already Assigned to this Operation Goverwr <br />Hods D. Sherman <br />P M (Please reference the file number currently assigned to this operatio1114aA . Dir.mor <br /> 5) Amendment Application (Rule 1.10) <br />4 <br />lication (Rule 1 <br />A <br />N Ronald w. canny <br /> . <br />. <br />ew <br />pp Division Director <br /> Conversion Application (Rule 1.11) N.ara1 Remmm Tnaim <br />Permit # _ !vim- _ (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 sinned 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 BM be bound or in a 3-ring binder; maps should be folded to <br />8 1/2" X 1 l" 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 />I . ADp lieant/operator or company name (name to be used on permit): City of Lafayette <br />1.1 Type of organization (corporation, partnership, etc.): Municipal Government <br />• <br />2. Ope ration name (pit, mine or site name): Goose Haven Reservoir #2 - Complex Expansion <br />3. Per mitter( •eMstee (new or existing site): 232.0 permitted acres <br />3.1 Change in acreage (+) acres <br />2 <br />3 e is Permit area <br />a <br />l <br />T <br />t 232.0 acres <br />. g <br />acre <br />o <br />a <br />4. Eff. <br />4.1 New Application <br />S2.6%.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) $2.6%.00 conversion fee <br />5. Hrlmarv commoditie(s) to beantned: 5ind"°o"w <br />5.1 Incidental commoditie(s) to be mined: 1. Fill Iltsrrons/vr, 2. N.AK Ibs/fons/yr <br />3. / (bs/Tons/vr 4. / lbs/fons/vr 5. / lbs/Pons/vr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: Construction Aggregate <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: Construction, Landscaping <br />Office Of Office of <br />Mined Land Reclamation Denver • Grand Junction • Durango "ve and Imalve Mines <br />0