2002-10-01_REVISION - M1977184

• Permit No: M1977184
• IBM Index Class Name: Revision
• Doc Date: 10/1/2002
• Doc Name: Permit Amendment Application
• From: City of Fort Collins
• To: DMG
• Type & Sequence: AM2
• Media Type: D
• Archive: No

ILE COPS
FOR SCAIVIVING
5'rATE of
DIVISION OF MINERALS AND GEOLOGY ~/ ~/CO
Department of Natural Resources O/+~ C
1313 Sherman St., Room 216 (.• 0
hone(( 03)866356703 CONSTRUCTION MATERIALS D~yts~OOOIMr ?~?~
a ~
FAX: [phone] REGULAR (112) OPERATION _~ eejo/S nrl eo/
RECLAMATION PERMIT APPLICATION FORM °9y
~~
DIVISION OF
MINERALS
GEOLOGY"
RECLAMATION
~MINING•SA FETY
Bill Owens
Governor
CHECK ONE: X There is a File Number A-ready Assigned to this Operation
Permit # M -12-~Z-1$ 4 (Please reference the file number currently assigned to this operation)
New Application (Rule 1.4.5)
X Amendment Application (Rule 1.I0)
_ Conversion Application (Rule 1.11)
Pemti[ # M -j~_-~--1$_4 (provide for Amendments and Conversions of e,dsting pemtits)
Greq E. watcher
Executive Director
Michael B. LOng
Division Director
The application for a Construction Materials Regulaz 112 Operation Reclamation Permit contains three major parts: (I) the application form;
(2) Ex}ubits A-S, Addendum 1, any sections of Exhibit 6.5 (Geotechttical Stability Exhibit; and (3) the application fee. When you submit yow
application, be sure to include one (1) complete sieved and notarized IVORY ORIGINAL and fow (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 NOT be 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 expedite processing, please provide the information in the format and order described in this form.
GENERAL OPERATION INFORMATION
Type or print clearly, in the space provided, alt information described below. ~ /
-~ . a r/
1. Apulicantloperator or comoanv name (name to be used o0 permit):
CI TY OF FORT COLLINS
1.1 Type of organization (wrpora[ion, partnership, etc.): MUN I C I P AL I T Y
1.2 I.R.S. Tax I.D. No. or Social Security Nttmber:
2. Ooerationname(oit,mineorsitename): TIMBERLINE PIT
3. Permitted acreage (new or eaistine skel: 10 9 . 1 2 permitted acres
3.1 Change in acreage (+) - acres
3.2 Total acreage in Permit area 109.12 acres
4. Fees:
4.1 New Application $2.344.00 application fee
4.2 New Quarry Application $2.906.00 quarry application
4.4 Amendment Fee $1.938.00 amendment fee
4.5 Conversion to 112 operation (set by statute) $2.344.00 conversion fee
5. Prim ary commoditie(sl to be mined: N A
5.1 Incidental commoditie(s) to be mined: 1. / Ibs/Tons/vr 2. / lbs/Tons/vr 3. / lbs/Tous/vr
4. / lbs/fonslvr 5. / lbs/Tons/vr
5.2 Anticipated end use of primary commoditie(s) to be mined:
5.3 Anticipated end use of incidental commoditie(s) to be mined:
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