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4. <br />5. <br />6. <br />7. <br />• REGULAR OPERATION (112) <br />RECLAMATION PERMIT <br />APPLICATION FORM <br />CHECK ONE: New Application (Rule 1.4.5) Amendment Application (Rule 1.10) <br />Conversion Application (Rule 1.11) <br />Permit No. M- (provide for amendments and conversions of existing <br />permits) <br />The application for a Regular Operation Reclamation Permit contains three major parts: (1) <br />the application form; (2) Exhibits A -S and Geotechnical Stability Exhibit; and, (3) the <br />application fee. When you submit your application, be sure to include'one (1) signed and <br />notarized original and four (4) copies of the application form, five (5) copies of Exhibits <br />A -R and any required sections of Exhibit S and the Geotechnical Stability Exhibit, and a <br />check for the application fee described under Section (16) on Page 3. Exhibits should not <br />be bound or in a 3 -ring binder; maps should be folded to 8 1/2" X 11" or 8 1/2" X 14" size. <br />To expedite processing, please provide the information in the format and order described <br />in this form. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, all information described below. <br />1. Applicant /operator or company name (name to be used on permit): <br />1.1 Type of organization (corporation, partnership, etc.): <br />1.2 I.R.S. Tax ID No. or Social Security Number: <br />2. Operation. name (pit, mine or site name)* <br />3. Permitted acreage (new or existing site) <br />3.1 Change in acreage (+ or -) <br />3.2 Total acreage in Permit area <br />Fees: <br />4.1 <br />4.2 <br />4.3 <br />4.4 <br />4.5 <br />New Application <br />New Quarry Application <br />Milling Application (Non -DMO) <br />Amendment Fee <br />Conversion to 112 operation (set <br />Primary commodities) to be mined: <br />Name of owner of surface of affected land: <br />Name of owner of subsurface rights of affected land: <br />If 2 or more owners, refer to Exhibit 0. <br />8. Type of mining operation: Surface _ Underground In -situ <br />9. Location Information: the center of the area where the majority of mining will <br />occur lies in: <br />COUNTY: <br />PRINCIPAL MERIDIAN (check one): 6th (Colorado) <br />SECTION (write number): S <br />TOWNSHIP (write number and check direction): T <br />RANGE (write number and check direction): R <br />QUARTER SECTION (check one): <br />QUARTER /QUARTER SECTION (check one): <br />GENERAL DESCRIPTION (miles and direction fro <br />elevation): <br />permitted acres <br />acres <br />acres <br />$1,875.00 application fee <br />$2,325.00 quarry application <br />$3,100.00 milling application <br />$1,550.00 amendment fee <br />by statute) $1,500.00 conversion fee <br />_ 10th (New Mexico) _ Ute <br />-- _ <br />North _ South <br />East West <br />NE NW SE SW <br />NE NW SE SW <br />m nearest town and approximate <br />