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iii iiiiiiiiiiiii tii <br />STATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />Depanmem o1 Natural Resources <br />1313 Sherman St., Room 215 <br />Denver, Colorado 80?03 <br />Phone: 1303) 8663567 <br />FAX: 1303) 833-8106 <br /> <br /> <br />CONSTRIICTION MATERIALS <br />LIMITED IMPACT (110) OPERATION <br />PERMIT <br />CHECK ONE: ~ New Application (Rule 1.4) <br />k?ECEIVED <br />HUG 61898 <br />DIV. OF MINERALS <br />8 GEOLOGY <br />FORM <br /> <br /> ~ ~ J <br />S Roy Ramer <br />e C. <br />R Governor <br />} <br />1~ ~ I ~ T lames S. Lochhead <br />i <br />i <br />(, Execul <br />oe D <br />rector <br /> Michael B. Long <br /> Division Director <br />Amendment Application (C.R.S. 34-32.5-110) <br />Conversion Application (Rule 1.11) <br />Permit # - -_ (provide for Amendments and Converaione of <br />existing permits) <br />The application for a Construction Materials Limited Impact (110) Operation Reclamation Permit <br />contains three major parts: (1) the application form; (2) 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'sioned 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 8 1/2" X 14" size. To <br />expedite processing, please provide the information in the format and order described in this <br />form. M , ~ p ~ <br />GENERAL OPERATION INFORMATION <br />Type or yrint clearly, is the space provided, ALL information described below. <br />1. Applicant/operator or company same (name to be used on permit): <br />Fryrear Gravel Pit - Richard (Dick) Fryrear <br />1.1 Type of organization (corporation, partnership, etc.): _ Individual Owner-Private <br />1.2 I.R.S. Tax ID No. or Social Security Number: <br />2. Operation name (pit, mine or site name): <br />3. Permitted acreage (new or existins site): <br />3.1 Change in acreage (+ or -) <br />Total Acreage in Permit Area <br />4. Fees <br />9.9 <br />permitted acres <br />acres <br />acres <br />4 .1 New Application 5 875.00 application fee <br /> Amendment Fee (C.R.S. 34-32.5-125(II)) 5 575.00 application fee <br />4 .2 Conversion Fee (from 110d to 110 85 75.00 conversion fee (Rule 1.11.2(2)) <br />5. Primar y commoditie(s) to be mined: Gravel Sand <br />5 .1 Incidental commoditie(s) to be mined: 1. 1bs/Tons/yr <br /> 2. / 1bs/Tons/vr 3. / lbs/Tons/vr <br /> 4. / lbs/Tons/yr 5. / lbs/Tons/vr <br />5. 2 Anticipated end use of primary commoditie(s) to be mined: Sale of gravel/sand <br />5. 3 Anticipated end use of incidental commoditie(s) to be mined : <br />Fryrear Gravel Pit <br />