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t+l'Al h UP LULUA�vU <br /> DIVISION OF RECLWATION,MINING AND SAFETY <br /> Department of Natural Resources <br /> 1313 Sherman st,Room Zi s tRUECLAMATION <br /> AA D O <br /> Denver.Colorado 80203 r o N o f <br /> Phone:(303)sss 3ss7 <br /> FAX:(303)M-8106 MINING <br /> SAFETY <br /> CONST UMON MATERIAT S <br /> REGULAR(112)OPERATION <br /> RECLAMATION PERT*W APPLICATION FORM <br /> CHECK ONE:[]__ There is a File Number Already Assigned to this Operation <br /> Perm t#_y - _ (Phase reference the file number currently assigned to this operation) <br /> New Application(Rule 1.4.5) D_AmendmentApplication(Rule,1.10) <br /> Conversion Application We 1-11) <br /> Permit# M - - - (provide for Amendments and Conversions of existing permits) <br /> The application for a Construction Materials Regular 112 Operation Reclamation Permit contains three major per:(1)the application <br /> form;(2)Exhibits A-S,Addendum 1,any sections of Exhibit 65(Geot echnicat Stability Exhibit;and(3)the application fee. When you <br /> submit your application,be sure to include one (1) Complete simed and notarized ORICKUL and one(1)copy of the completed <br /> applicationform,two(2)copies ofExlnbits A-S,Addendum 1,appropriate sections of 6.5(Geotechnicat StabilityExlubit,and a checkfor <br /> the application fee described under Section(4)below Exbibits should NOT be bound or in a 34i49 binder,maps should be folded to <br /> 8 1/2"X I1"or 81/2"X 14"size. To expedite processing,please provide the information inthe 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. Aim&cautloaerator or company name(name to be used oa permit <br /> : <br /> 1.1 Type of organization(corporation,partnership,etc.): c©utar ck}"►01t1 L C- <br /> 2. Operation name(nit.mine or site name) <br /> 3. Permitted acreage(Raw or existing site): _/ _ Permitted acres <br /> 3.1 Change in acreage(+) acres <br /> 3.2 Total acreage in Permit area _ acres <br /> 4_ Fees: <br /> 4.1 New Application $2.696.00 application fee <br /> 42 New Quarry Application $3,342.00 quarry application <br /> 4A Amendment Fee 52229.00 amendment fee <br /> 4_5 Conversion to 112 operation(set by slatate) �2.696.00 conversion fee <br /> 5. Primary commodities)to be mined: <br /> 5.1 Incidental commoditie(s)to be mined: 1_ ��c. i- t lbstrs�sfyr 2. .,got / .27brz-y01b9 n��Jyr <br /> 3- / lbs/Tonsh+r 4. / IbAgons/yr S. J Ib§gons/u <br /> 5.2 Anticipated end use of primary commodities)to be mined: G.xyt1 ;Ay% cft +s <br /> 3.3 Anticipated end use of incidental commaoditie(s) - <br /> 0 C T 1 8 2022 ` <br /> .By............ <br />