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2 `TE OF COLORADO <br /> DIVISION AMA <br /> Department, M2010-071 1 Violation <br /> 1313 Sherma /Comp <br /> lied! AMElmac <br /> Denver,Coloi 6 Minor Infractions C O L O RA D O <br /> Phone:(303) DIVISION OF <br /> FAX:(303)83 RECLAMATION <br /> NO ENVEI.pPE hand delivered MINING <br /> T INCLUDED! —&— <br /> *NO PAY VIEN SAFET'Y>, r, <br /> �...v� tION MATERIALS <br /> REGULAR(112)OPERATION <br /> RECLAMATION PERMIT APPLICATION FORM 0N1310N OF '�CLA <br /> MINiNp$SA"rrON <br /> V <br /> CHECK ONE:I There is a File Number Already Assigned to this Operation <br /> Permit# M20 10 071 (Please reference the file number currently assigned to this operation) <br /> New Application(Rule 1.4.5) Amendment Application(Rule 1.10) <br /> D—Conversion Application(Rule 1.11) <br /> Permit# M 2010 Q71 AM2 (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 I I"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): CITY OF LAFAYETTE <br /> 1.1 Type of organization(corporation,partnership,etc.): MUNICIPAL, GOVERNMENT <br /> 2. Operation name(pit,mine or site name): GOOSE HAVEN RESERVOIRS COMPLEX EXPANSION #2 & #4 <br /> 3. Permitted acreage(new or existing site): 232 permitted acres <br /> 3.1 Change in acreage(+) 0 acres <br /> 3.2 Total acreage in Permit area 232 acres <br /> 4. Fees: <br /> 4.1 New Application $2,696.00 application fee <br /> 4.2 New Quarry Application $3,342.00 quarry application <br /> 4.4 Amendment Fee $2,229.00 amendment fee <br /> 4.5 Conversion to 112 operation(set by statute) $2,696.00 conversion fee <br /> 5. Primary commoditie(s)to be mined: SAND GRAVEL <br /> 5.1 Incidental commoditie(s)to be mined: 1. FILL NA lbs/Tons/vr 2. / lbs/Tons/yr <br /> 3. / lbs/Tons/yr 4. / Ibs/Tons/yr 5. / Ibs/Tons/yr <br /> 5.2 Anticipated end use of primary commoditie(s)to be mined: CONSTRUCTION <br /> 5.3 Anticipated end use of incidental commoditie(s)to be mined: CONSTRUCTION <br />