REV13706

• Permit No: M1978249
• IBM Index Class Name: Revision
• Doc Date: 10/25/2001
• Doc Name: CONSTRUCTION MATERIALS REGULAR 112 OPERATION RECLAMATION PERMIT APPLICATION FORM
• Type & Sequence: CN1
• Media Type: D
• Archive: No

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s~rATr. or co~or~Do
DIVISION OF MINERALS AND GEOLOGY
Oepanmene of Nam~al Resources ~•.v~>' "0 "`-
131 3 Sherman St.. Room ? 15 ~t~L~ Y
Denver, Colorado 60?03 s iq~
Phone: [phone] CONSTRUCTION MATERIALS QCj 2 "J `~U~l
FAX: [phone]?-8106 REGULAR (112) OPERATION
RECLAMATION PERMIT APPLICATION FO~(i¢tt of Minerals and
~~
DI VISION U`
MINERALS
GEOLOGY
R ECIAMgiION
MINING•$AFET1
B;It Owens
Grvernor
CI-<ECK ONE: ~, There is a File Number Already Assigned to this Operation
Permit # M -3&- 249_ (Pleax refere¢ce the fde number cture¢tly assig¢ed to this operation)
New Application (Rule 1.4.5)
Greg E. Walther
Executive Obenor
M¢hael B. Long
Amendment Applicatio¢ (Rule 1.10) O,vly~on olreoor
_~ Convenioo Applicatio¢ (Rule I.11)
Permit # M - 78 - 249 -_ (provide for Amendments a¢d Co¢versioos of existing pemtits)
The appbcation for a Construction Materials Regular 112 Operation Reclamation Permit contains three major parts: (i) 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
appbcation, be swe to include one (1) co~lete sieved a¢d notarized IVORY ORIGINAL and four (4) copies of the completed Ivort,
application form, five (5) copies of Exhibits A-S. Addendum I, appropriate sections of 6.5 (Geolechnical Stabilin~ Exhibit, a¢d 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 11" size. To expedite processing, please provide the information in the format and order described in this form.
GENERAL OPERATTON INFORMATION
Type or pri¢t clearly, in the space provided, all information described below. ~~ ~ ~~~,~
A,policant/ooerator or company Dame (name [o be used on oermitl:
Logan County
1.1 Type of organization (corporation, pannership, etc.): Colmtp Government
1.2 I.R.S. Tan I.D. No. or Social Sectrrity Number:
2.
3.
Operation name tpit, mine or site unmet:
Permitted acrea¢e fnew or eaistin¢ sitel:
3.1 Change in acreage (+)
3.2 Total acreage in Petmit area
4.
Fees
Kokes Gravel Fit
4. I New Application
1.2 New Quarry Application
1.1 Ame¢dme¢t Fee
15 Conversion to 1 12 operation (set by statute)
5.
Primary commoditie(s1 to be mined: Sand Gravel
9.9 permitted acres
] 0.23 acres
20.13 acres
$2.314.00 application fee
$2,906.00 quam' application
$1.938.00 amendment fee
$2.344.00 :,onversion fee
5.1 Incidental commoditie(s) to be mined: 1. / Ibs/fons/yr 2. / Ibs/fo¢s/vr 3. / Ibs/To¢s/vr
1. / Ibs~fo¢shT 5. / Ibs/fons/vr
5.2 Anticipated end use of primary commoditie(s) to be mined: County Roads -
5.3 Anticipated e¢d use of incidental commoditie(s) to be mined: