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DIVISION OF RECLAMATION, MINING AND SAFETY <br />Department of Natural Resources <br />1313 Sherman St., Room 215 <br />Denver, Colorado 80203 <br />Phone: (303) 868 -3567 <br />FAX: (303) 832 -6106 <br />STATE OF COLORADO <br />CONSTRUCTION MATERIALS <br />REGULAR (112) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />CHECK ONE: Q— There is a File Number Already Assigned to this Operation <br />C,v 1 <br />COLORADO <br />D I V I S I O N O F <br />RECLAMATION <br />MINING <br />SAFETY <br />Permit # M - 2005 - 044 (Please reference the file number currently assigned to this operation) <br />New Application (Rule 1.4.5) Amendment Application (Rule 1.10) <br />Conversion Application (Rule 1.11) <br />Permit # M - 2005 - 044 (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 pu <br />submit your application, be sure to include one (1) complete signed and notarized ORIGINAL and one (1) copy of the complHed <br />application form, two (2) copies of Exhibits A -S, Addendum 1, appropriate sections of 6.5 (Geotechnical Stability Exhibit, and a checaor <br />the application fee described under Section (4) below. Exhibits should NOT be bound or in a 3 -ring binder, maps should be foldetto <br />8 1/2" X 11" or 8 1/2" X 14" size. To expedite processing, please provide the information in the foment and order described in this foWn. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, ALL Information requested below. <br />1. Applicaut/operator or company name (same to be and on permit): UnCOIn COu <br />1.1 Type of organization (corporation, partnership, etc.): Local Government <br />2. Operation name (pit, mine or site uame): Hoffman Pit <br />3. Permitted acresee (pew or existing site): <br />9•90 <br />permitted acres <br />3.1 <br />Change in acreage ( +) <br />24.2 <br />acres <br />31 <br />Total acreage in Permit area <br />34.1 <br />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 />53,342.00 <br />quart' 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 />52.696.00 <br />conversion fee <br />Sand Gravel <br />5. Primary <br />commodities) to be mined: <br />5.1 <br />Incidental eommoditie(s) to be mined: 1. None <br />Ibs/Tons/vr 2. / <br />)bs/rons/vr <br />3. / 1bs/Torts/vr 4. / <br />Ibs/Tons/vr 5. / <br />Ibs/Tons/vr <br />5.2 <br />Anticipated end use of primary commodities) to be mined: <br />County Road Maintenance <br />5.3 <br />Anticipated end use of incidental commoditie(s) to be mined: <br />N/A <br />