REV11265

• Permit No: M1994007
• IBM Index Class Name: Revision
• Doc Date: 1/2/1997
• Doc Name: CONSTRUCTION MATERIALS REGULAR 112 OPERATION RECLAMATION PERMIT APPLICTION FORM
• Type & Sequence: CN1
• Media Type: D
• Archive: No

DIVISION OF MINERALS AND GEOLOGY
Department of Natural Resourres
1313 Sherman St., Room 215
Denver, Colorado 80203
Phone: [phone]
FAX: [phone]
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DEPARTMENT OF
NATURAL
RESOURCES
coersTRacrxoM MA~n*•*•s
REGQLAA (111) OPBRATIOH
fATION P8RMIT APPLIGTIOM FORM
Roy Romer
Governor
lames 5. Lochhead
Eaecurive Director
Michael B. Long
Divisnn Director
CHECK ONE: - New Application (Rule 1.4.5) 1in~~a"^~~t Application (Rule 1.10)
XX Comraraion Application (Rule 1.11)
Permit # M _ 94 _ 007 __ (provide for Ameadmenta and Coavereioas of
existing permits)
The application for {{tt Construction Materials Regular 112 Operation Reclamation Permit contains
three major parts: (1) the application form; (2) Exhibits A-S, Addendum 1, any sections of
Exhibit 6.5 (Geotechnical Stability Exhibit; and (3) the application fee. When you submit your
application, be sure to include one (1) complete sinned and notarized IVORY ORIOTwrT- and four (4)
copies of the completed Ivory application form, five (5) copies of Exhibits A-S, Addendum 1,
appropriate sections of 6.5 (Geotechnical Stability Exhibit, and a check for the application fee
described under Section (4) below. Exhibits should MOT be bound or in a 3-ring binder; maps
should be folded to B 1/2" X 11" or 8 1/2" X 14" size. To expedite processing, please provide
the information in the format and order described in this form.
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GENERAL OPERATION INFORMATION
Type or print clearly, in the apnea provided, ALL information requested belor.
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1. ApDllcaat/operator or COmptnly IIaID6 (aaIDe to ba used oa permit):
1.1 Type of organization (corporation, partnership, etc.): la OV ernnlenL
1.2 I.R.S. Tax I.D. No. or Social Security Number:
2. operation acme (pit, mine or Bite name): JOhn50n Plt
3. Permitted acraaae (new or azfetiaa site):
3.1 Change in acreage (+ or -)
3.2 Total acreage in Permit area
4. Feae:
9.9 permitted acres
+42.4 acres
52.3 acres
4.1 New Application
4.2 New Quarry Application
4.3 Milling Application (Non-DMO)
4.4 Amendment Fee
4.5 Conversion to 112 operation (set by statute)
s. Pri+tiw commoditie(s) to ba mined: Sand Gravel
51,875.00 application fee
52,325.00 quarry application
X3,100.00 milling application
51,550.00 amendment fee
$1,875.00 conversion fee
5.1 Incidental commoditie(s) to be mined: 1. lbs/TOnslyr
2. / lbs/Tons/vr 3. / lbs/Tons/vr
4. ( lbslTonslvr 5. 1 lbs/Tons/yr
5.2 Anticipated end use of primary commoditie(s) to be mined: COnStrUCtiOn/ROadS
5.3 Anticipated end use of incidental commoditie(s) to be mined: