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~\ <br />` ~ III'IIII"II'III'II • <br />..:~9 ,~ ~ OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />Department of N.In,ral Resources RECEIVED <br />I S I S Sherman St.. Rnum 215 D I V I S I O N O F ~ <br />Denver, Colorado 8020] APR 1 2 2001 MINERALS <br />Phone~(703186G-35h7 & <br />FAx: LSOA N3'_-8106 <br />Division of Minerals end Geolapy GEOLOGY <br />CONSTRUCTION MATERIALS M EN I N GMS A F E T Y <br />REGULAR (112) OPERATION <br />RE(:LAMATION PERMIT APPLICATION FORM e~Il ovens <br />Governor <br />Greti E. Walther <br />Enecmive D~reUOr <br />CHECK ONE: New A lication P'.ule 1.4.5 Amendment A lication Rule I.10`~'chael 8. Lonq <br />~_ pp ( ) --_ PP ( Dwlslon Dkeaor <br />_~ Conversion Application (Rule 1.1 I j <br />Permit # M - ~3 - /S9 -,_ (provide for Aroeodmenrs and Conversions ofexisting petmirs) <br />The application for a Construction Materials Regular 112 Operation Reclamation Permit contains three major parts: (I) the application form; <br />(2) Exhibits A-S, Addendum 1, any sections ofExhibh6.5 (Geotechnical Stability Exhibit; and (3) the application fee. When you submit your <br />application, be sure to include one (1) c~molete sided and notarized IVORY ORIGINAL and four (4) copies of the completed Ivory <br />application form, five (5) copies of Exhibits A-S, Addendum 1, appropriate sections of 6.5 (Geotechnical Stability Exhibit, and a check for <br />the application fee described under Section (4) below. Exhibits should NOT be bound or in a 3-ring binder; maps should be folded to <br />8 1/2" X 1 I" or 8 1/2" X 14" size. To expedite processing, please provide the information in the format and order described in this form. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, im the space provided, ALL information requested below. <br />1. AooGcaotiooerator or compaov none (Dame to be used o0 oermitl: ,tgamEe ~ ! J.l-c~ PNc7in ~l ~O, ~n C , <br />1.1 Type of organi7ation (corporation, partnership, etc.): t" aPOe a'nn.r <br />1.2 I.R.S. Tax I.D. No. or Social Security Number: ~'~- //S~$G / <br />2. Ooerstiom Dame (tit. mine or site oa e : b Lr A~-•I f 1 T <br />3. Permitted acreaee (Dew or existinE site : ~ permitted acres <br />3.1 Change in acreage (+) ~~~ acres <br />3.2 Tote! acreage in Perini[ area 39•t 8~ acres <br />4. Fees <br />4.1 New Application 51,875.00 application fee <br />4.2 New Quarry Application 52.325.00 quarry application <br />4.3 Milling Application (Non-DMp) 53.100.00 milling application <br />4.4 Amendment Fee 51.550.00 amendment fee <br />4.5 Conversion to 1 l2 operation (set by statute) 51.875.00 conversion fee <br /> ` 1 n <br />S. Primary commoditie(sl to be mined: ~7 ~ J Y <br />, <br />, HQ (~6~Al~C <br />5.1 1, ~~QDO - Sg01~YI <br />: <br />Incidental commoditie(s) to be mined Ibsf .oF1vr 2. / Ibs/fons/vr <br /> 3. / IbslfonshLr 4, / Ibs/Tons/vr 5. / IbsJfons/yr <br />5? Anticipazed end use of primary commodities} to be mined: r <br />~ rt <br /> ~ <br />,~/ <br />d <br />~ <br />' <br />l7 <br />D ~ ~J <br />~ / <br />'1 <br />1 <br />~ <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: rra <br />, <br />aas <br />.n <br />oR rLG 4 rv <br />JO ~ <br />e <br /> <br />