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5 <br />STATE OF <br />DIVISION OF MINE~~QyQf~ <br />Department of Natural R ~~ ~~ GG VV / <br />13135hertnan bt., Room 215 . / t~~~f~ ~®~~ RECF~~~D <br />Denver, Colorado 80203 NUt/ 0 6 20~ "'~VV/ kkff [[~~ <br />Phone: (303)866-3567 YY ., ., ~® ~~~~pp4~®~yl ~ „ a nq <br />FAX: (303) 632-8106 ®~' ®~ ~ ~ (; L~W <br />pivision of Minerals and GeoloOY <br />Gtvisiwi m rvnuerals and fiapla~ <br />~n J O~^ CONSTRIICTIONMATEBIAIS / <br />~ ~ /J (~ REGULAR (212) OPERATION V/ <br />RECLAMATION PERMIT APPLICATION FORM <br />CHECK ONE: There is a Fae Npmber Already Assigned to this Operation <br />Petmit # M -_-_-_ mlease ref the file mm~ber cmren8y assig¢ed to this operation) <br />New Application (Role 1.4.3~~ ~ y0 _ Amendmept Applicaflan (Rule 1.10) <br />Conversion Application (Rule 1.11) <br />Pepnii # M -1oa~(pravide fair Amendments and Cons~ereions of exisTing pemtits) <br />DIVISION O F <br />MINERALS <br />GEOLOGY <br />RECLAMATION <br />MINING•SAFETY <br />Etill Owens <br />(-,ovemor <br />Greg E. Walther <br />fzecutive Director <br />Ronald W. Cattany <br />Acing Division Director <br />The application for a Constriction Materials Regular 112 Operation Reclamation Peffit contains three majorpazts: (1) the appEcation form; <br />(2) Exhibits A-S, Addendum 1, say sections ofExhrbit 65 (Geotechuical Stabrlr'ty Exhtbit and (3) ffie application fee. When yon submit your <br />applicatia~n, be sure to include one (1) camolete sicned and notarized IVORY ORIGINAL, and offi (1) copy of the completed ~ application <br />folm, two (2) copies ofF,xlubits A-S, Addendmm I, appropriate sections of 6.5 (Geotechnical Stabrlity Exhibit, and a check far the application <br />fee descnbed order Section (4) below. F.xlubits should NOS 6e bomd or is a 3-ring binder; maps shceld be folded W 8 12" X I I" or 8 I/2" <br />X 14" size. To expedite processing, please provide the infoDnatiDn in the format and order descnbedm this foss <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, ip the apace provided, ALL information requested below. <br />I. AoHlicanr/ocerator or oonsnanv name (name to be need on Hermit): ~~.~ ~ L7/P~ <br />1.1 T e Of nromri>~tirm ~ -~ <br />S'P a (corporation, partnership, etc.): ~l!//l~Ele <br />1.2 I.RS. Tax ID. No. or Social Security Number: <br />2. Operation name (pit, wipe or site name): <br />3. Permitted acreage (new or eaistinQ site): <br />3.1 Change in acreage (+) <br />32 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 />45 Conversion to 112 operation (set by smtrde) <br />5. Primary commoditie(s) to be mined: ~A' L~ ~~ <br />5.1 Incidental commoditie(s) to be mined: 1. ~r ~- Ibs/To <br />3. / Ibs/1'onslvr 4. <br />5.2 Anticipated end tlse of primary commoditie(s) to be mined: _ <br />pemutted acres <br />$2 344.00 application fee <br />$2.906.00 gnmry application <br />$1 938.00 amendment fee <br />$2.344.00 conaersionfee <br />2. _ / Ibs/Cansiyr <br />5. 1 lbs/Trms/vr <br />5.3 Anticipated end nse of incidental commoditie(s) to be mined: <br />