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II ~II~II~II~~II III <br />999 <br />DIVISION OF MINERALS AND GEOLOGF( <br />Uepartmenl of Natural Resources <br />1313 Sherman St., R,wm 115 <br />Denser. Colorado 80203 <br />Phone: (30318h6-3567 <br />FAX 1303183b8106 <br />1`~ ~ <br />~~~ ,N;d`~ta~s~'G <br />.~c~,0 <br />CONSTRUCTION MATERIALS <br />DIVISION OE <br />MINERALS <br />6s <br />GEOLOGY <br />R E C L A M A T I O N <br />MINING•SAEETY <br />Bill Owens <br />LIMITED IMPACT (110) OPERATION Governor <br />Greg E. Wakher <br />RECLAMATION PERMIT APPLICATION FORM Executive Director <br />Michael B. Long <br />Division Director <br />CHECK ONE: ~~ X New Application (Rule 1.4) <br />Conversion Application (Rule 1.11) <br />Amendment Application (C.R.S. 34-32.5-110) <br />Permit # v~1 ~~~9 (provide for Amendments and Coovenioos of existing permits) <br />The application for a Construction Materials L•mrited Impact (110) Operation Reclamation Permit contains three major parts: (I) the application forth; <br />(2) Exhibits A-J, Exhibit L, Addendum 1, arty sections of Ezhiba 6.5 and Geotechnical Stability Exhibit, as required by the O[fice, and outlined in Rules <br />6.1, 6.2, 6.3, 6.5, and 1.6.2(1)(b); and (3) the application fee. When you submit your application, be sure to include one (1) clrlolete signed and <br />notarized IVORY ORIGINAL and one (1) copy of the completed vo application form, two (2) copies of Exhibits A-l, Exhibit L, Addendum I, and <br />appropriate sections of 6.5 (Geotechnical Stability Exhibit), as required, and a check for the application fee described under (4) below. Exhibiu should <br />NOT be bound or in a 3-ring binder, maps should be folded to 8 12" X 11" or 8 12" X 14" size. To expedite processing, please provide the information <br />in the fotmaz and order described in this form. !J / _., _ _,_ <br />OPERATION INFORMATION <br />Type or print cleaAy, in the spatt provided, ALL information described below. <br />AoolineUonentororcomoaovname(nametobeusedoooermitl: Randy Perdue <br />I .l Type of organization (corporatioM partnership, etc.): S o l e P r op r i e t o r s h i R <br />1.2 i.R.S. Tax ID No. or Social Security Number: <br />2. Operation name foil, mine or site namel: Perdue <br />3. Permitted acreage (new or existine site): 6 permitted acres <br />3.1 Change in acreage (+) acres <br />Total Acreage in Permit Area ~ acres <br />4. Fees: `~G 4`00 <br />4.1 New Application: 8 00 application fee <br />Amendment Fee (C.R.S. 34-32.5-125(11)): 5575.00 applicazion fee <br />4.2 Conversion Fee (from 1 I Od to 110 575.00 conversion fee (Rule 1.11.2(2)) <br />5. Primarvcommoditie(s)tobemined: sandstone <br />5.1 Incidental commoditie(s)to be mined: 1. none' Ibs/fons~ 2. / Ibs/fons/vr 3. / Ibsll ohs/vr <br />4. / Ibs/fons/vr 5. / Ibs/fons/vr <br />5.2 Anticipa[edenduseofprimarycommoditie(s)tobemined: LandscapinH / Decorative Stone <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: N/ A <br /> <br />~'E, OF COLORADO <br />