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DIVISION OF RECLAMATION, MINING AND SAFETY <br />Department of Natural Resources <br />1313 Sherman St., Room 215 ED <br />Denver, Colorado 80203 R�c��� <br />Phone: (303) 866-3567 CONSTRUCTION MATERIALS <br />FAX: (303) 832 -8106 n n 2011 REGULAR (112) OPERATION <br />0- RECL l <br />G o �N F <br />r 10 A& <br />CHECK ONE: El ile Number Already Assigned to this Operation <br />Harris D. Sherman <br />Pe • M SDI( -Q Q_ (Please reference the file number currently assigned to this operatioa)ecu Director <br />!-- New Application (Rule 1.4.5) F, Amendment Application (Rule 1.10) <br />Conversion Application (Rule 1.11) <br />Permit # M <br />PERMIT APPLICATION FORM <br />(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. Applicant/operator or company name (name to be used on permit): Moffat County Board of County Commissioners' <br />1.1 Type of organization (corporation, partnership, etc.): 1()cal Go v e r n m P n t <br />2. Operation name (pit, mine or site name): Limestone Pit No. 10 <br />3. Permitted acreage (new or existing site): <br />3.1 Change in acreage ( +) <br />3.2 Total acreage in Permit area <br />5. Primary commoditie(s) to be mined: Limestone C l ray <br />5.1 Incidental commoditie(s) to be mined: 1. N/A - lbs/Tons/vr <br />3. / lbs/Tons/vr 4. / lbs/Tons /vr <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: N/A <br />Office of <br />Mined land Reclamation ' Denver • Grand Junction • Durango <br />JMC- <br />55 s <br />STATE OF COLORADO <br />Sand <br />2. <br />5. <br />86.4 <br />0 <br />R6 4 <br />4. Fees: <br />4.1 New Application X X X $2,696.00 <br />4.2 New Quarry Application $3,342.00 <br />4.4 Amendment Fee $2,229.00 <br />4.5 Conversion to 112 operation (set by statute) $2,696.00 <br />5.2 Anticipated end use of primary commoditie(s) to be mined: Road Cons t r u r t i nn Ma t e r i a l <br />COLORADO <br />D I V I S I O N O F <br />RECLAMATION <br />MINING <br />SAFETY <br />Bill Ritter, Jr. <br />Governor <br />Ronald W. Cattany <br />Division Director <br />Natural Resource Trustee <br />permitted acres <br />acres <br />acres <br />application fee <br />quarry application <br />amendment fee <br />conversion fee <br />Gravel <br />lbs/Tons/vr <br />lbs/Tons/vr <br />Office of <br />Active and Inactive Mines <br />