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ECEIVED <br />CONSTRUCTION MATERIALS SEP 2 9 2004 ~ <br />REGULAR (112) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM /Division of Miner~lsend Geolnpy <br />CHECK ONE: ~ There is a File Number Already Assigned [o this Operation <br />Permit # M -~~[~~}_ (Please reference the tle number currently assigned to this operation) <br />New Application (Rule 1.4.5) ~ Amendment Application (Rule 1.10) ^n <br />Conversion Application (Rule 1.11) rl l r { ~ l ~/ <br />Permit # M -~ - (provide for Amendments and Conversions of existing permits) <br />The application for a Conslruc[ion Materials Regular 112 Operation Reclamation Permit contains three major parts: (1) the application <br />form; (2) Exhibits A-S, Addendum 1, any sections of Exhibit 6.5 (Geo[echnicai Stability Exhibit; and (3) the application fee. When you <br />submit your application, be sure [o include one (1) complete sinned and notarized ORIGINAL and one (1) copy of the completed <br />application form, two (2) 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 [o <br />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. <br />GENERAL OPERATION MFORMATION <br />Type or print clearly, in the space provided, ALL information requested below. <br />1. Applicant/operator or company name (name to be used on permit): ~ ~ ~l ~ Eilc K. )JTt ~rtilC -'~ <br />1.1 Type of organization (corporation, partnership, etc.): ~/'~ P~~A7t tJr~i <br />1.2 LR.S. Tax LD. No. or Social Security Number: ~~L' 022.~(aC~/ <br />2. Operation name /pit. mine or site namel: <br />3. Permitted acreage (new or existing site): <br />3.1 Change in acreage (+) <br />3.2 Total acreage in Permit area <br />4. Fees <br />-r L~P~ ~~'~ ~ 6~au~-M.ti~C r/ <br />-y~- permitted acres <br />L ~~~C-~ acres <br />~( acres <br />4.1 New Application $2,344.00 application fee <br />4.2 New Quarry Application $2,906.00 quarry application <br />4.4 Amendment Fee $1,938.00 amendment fee <br />4.5 st <br />at <br />u <br />t <br />e) <br />Conversion to 112 operation (set by $2,344.00 conversion fee <br />p <br />~ <br />" <br />" <br />~ <br />5. Primary commoditie(s) to be mined: ~•_~'iU1e. I <br />5.1 Incidental commoditie(s) to be mined: 1. - Ibs/Tons/vr 2. / Ibs/Tons/vr <br /> 3. / 1bsITons/vr 4. / Ibs/Tons/vr 5. / Ibs/Tons/yr <br />5.2 Anticipated end use of primary commoditie(s) [o be mined: s //G9-/ bLl,.. ~lG /'¢C GL~-~ <br /> <br />5.3 <br />Anticipated end use of incidental commoditie(s) to be mined: l1 ~VI ~ 1 ,t <br />GSM Il ~~ t D U/t' i <br /> <br />