Laserfiche WebLink
app K cr,~ ~^- <br />~y- ~ oos-- o~ <br />RECEIVED <br />NOV 0 31005 <br />MATERIALS <br />REGULAR (112) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />Division of Minerals and GeoloBY <br />CHECK ONE: There is a File Number Already Assigned to this Operation <br />Pemut # M ---_ (Please reference the file number currently assigned to this operation) <br />X New Application (Rule 1.4.5) _ Amendment Application (Rule 1.10) <br />Conversion Application (Rule 1.11) <br />Permit # M - -_ (provide for Ameedmeets and Conversions of existing permits) <br />The application for a Construction Materials Regular 112 Operation Reclamation Pemut contains three major parts: (1) the application <br />form; (2) Exhibits A-S, Addendum 1, any sections ofExhibi[ 6.5 (Geotechnical Stability Exhibit; and (3) the application fee. When you <br />submit your application, be sure to include one (1) complete sianed and notarized ORIGINAL and one (1) copy of the completed <br />application fonn, 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 fomrat and order described in this fomt. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, ALL informatioe requested below. <br />1. AooticanUocerator or comoanv name (uame to be used on oermitl: EnCana Oil 8 Gas (USA), Ino. <br />1.1 Type of organization (corporation, partnership, etc.): wrpor <br />1.2 I.R.S. Tax I.D. No. or Social Security Number: <br />2. Oceration name (oit, mine or site name): west FOrk Pit <br />3. Permitted acreage tnew or ezistin¢ site): <br />3.1 Change in acreage (+) <br />3.2 Total acreage in Permit area <br />4. Fees: <br />4.1 New Application <br />4.2 New Quarry Application <br />4.4 Amendment Fee <br />4.5 Corrversion to 112 operation (set by statute) <br />5. Primary commoditie(s) to be mined: Gravel <br />5.1 Incidental commoditie(s) to be mined: 1. - IbslTons/vr <br />18.4 permitted acres <br />acres <br />18.4 acres <br />$2 344.00 application fee <br />$2 906.00 quany application <br />$1,938.00 amendment fee <br />$2.344.00 conversion fee <br />2. / ]bs/I'ons/vr <br />3. / lbs/I'onsWr 4. / lbs/1'ons/vr 5. / ]bs/I'onslvr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: Construction Materials <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: None <br />