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ii ii«ui~ni» iii <br />;~ STATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />Depanment of NamrafResoumes <br />1313 Sherman 81., Room?1$ <br />Derner, Colorado 80103 <br />Phone. (303) 866356% <br />FAX: (3031 83?-8106 <br />° RECEIVED <br />MAR 11 1998 <br />MATERIALS <br />Division of Minerals & Geology <br />LIMITED IMPACT (110) OPERATION <br />t~''~ <br />DEPARTMENT OF <br />NATURAL <br />RESOURCES <br />Roy Romer <br />Governor <br />RECLAMATION PERMIT APPLICATION FORM fames S. Lochhead <br />E<ecunve Direnar <br />Michael B. LOng <br />Divis'~on D'necror <br />CHECK ONE: X New Application iRule 1.4) Amendment Application (C.R.S. 34-32.5-110) <br />Conversion Application (Rule 1.11) <br />Permit'# - -_ (provide for Ameadmeats and Conversions of <br />existing permits! <br />The application for a Construction Materials Limited Impacr (110) Operation Reclamation Permit <br />contains three major parts: (1) the application form; i2) Exhibits A-J, Exhibit L, Addendum 1, <br />any sections of Exhibit 6.5 and Geotechnical Stability Exhibit, as required by the Office, and <br />outlined in Rules 6.1, 6.2, 6.3, 6.5, and 1.6.2(1)(b); and (3) the application fee. When you <br />submit your application, be sure to include one (1) complete"signed and notarized IVORY ORIGINAL <br />and one (1) copy of the completed Ivory application form, two (2) copies of Exhibits A-J, <br />Exhibit L, Addendum 1, and appropriate sections of 6.5 (Geotechnical Stability Exhibit), as <br />required, and a check for the application fee described under (4) below. Exhibits should NOT be <br />bound or in a 3-ring binder; maps should be folded to 8 1/2" X 11" or B 1(2" X 14" site. To <br />expedite processing, please provide the information in the format and order described in this <br />form. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, is the space provided, ALL information described below, <br />---------------------------------------------------------------------------------------------- <br />1. Applicant/operator or company name (name to be used on permit): <br />I',RANT1 f:RAVF. T, rn' ~O ~ ~ I / <br />1.1 Type of organization (corporation, partnership, etc.):IEL~j, <br />1.2 I.R.S. Tax ID No. or Social Security Number: <br />2. Operation game (pit, mine or site name): GRAND GRAVEL <br />3. Permitted acreage (new or exietiag site): 9.6 NEW permitted acres <br />3.1 Change in acreage (+ or -) acres <br /> Total Acreage in Permit Area g•8 acres <br /> <br />4. Fees: <br />4.1 New Application 5875.00 application fee <br /> Amendment Fee (C.R.S. 34-32.5-125(II)) 5575.00 application fee <br />4.2 Conversion Fee (from 110d to 110 875 5.00 conversion fee (Rule 1.11.2(2)) <br />5. Primar y commoditie(s) to be mined: (7RAVRT, <br />5.1 Incidental commoditie(s) to be mined: 1 NONE lbs/Tons/vr <br /> 2. ~ 1bs/TOnsJvr 3. NONE / lbs/Tons/vr <br /> 4. / lbs/Tonslvr 5. NONE / lbs/Tons/vr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: pRF. A C;RAVRT. PF.MANT) <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: NONE <br />