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[/~i ~a ~ S ~ bpi ~-Na l ~ece rid ~~ <br />STATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />Department of Namnl Resources /~~~ ... , <br />1373 Shemlan SL, Room 215 liJ " C O L O RA D O <br />Denver, Colorado 80203 SEP 2 U 2005 DIVISION O F <br />Phone: 1303) 8643567 ONSTRUCTION MATERIALS M I N E~ L S <br />FAx: 1303) 832.8706 REGULAR (112) OPERATION ~ E O L O G Y <br />Division of htinamis & Duolo eeLANenoN•NININe <br />RECLAMATION PERMIT APPLICATION FORM EAEETT•3OENCf <br />Bill Owens <br />Governor <br />CHECK ONE: There is a File N~ umbe/r'Alresdy Aeaigned to this Operation RlnseB eeorge <br />Permit # M -~-~ l/ (please reference the file number currently assigned to this operation) F'°°'tive Dileaor <br />Rwuld W. fanany <br />_ New Application (Rule 1.4.5) Amendment Application (Rule L 10) oivisirn oilector <br />L(_ Conversion Application (Rule 1.1 1) Naunl Resourte Tmstee <br />Permit # M -_ i (provide for Amendments and Conversions of existing pcrnits) <br />The application for a Construction Materials Regulaz 1 12 Operation Reclamation Permit wntains three major parts: (I) the application form; <br />(2) Exhibits A-S, Addendum 1, any sections of Exhibit 6.5 (Geotechnical Stability Exhibit; and (3) the application fee. When you submi[your <br />application, be sure to include one (I) complete simed and rsotarized ORIGINAL and one (1) copy of the completed application fomL two (2) <br />copies of Exhibits A-S, Addendum 1, appropriate sections of 6.5 (Geotechnical Stability Exhibit, and a check for the application fee described <br />under Section (4) lselow. Exhibits should NOT be botmd m in a 3-ring binder; maps should be folded to 8 1 /2" X 1 I" or 8 12" X 14"size, To <br />expsxlite processing, please provide the information in the format and order described in this form. <br />GENERAL OPERATION <br />Type or print clearly, in the spatt provided, ALL information requLxted bebw. <br />1. Apnlicaotloperator or wmmanv name (name to be used on Dermit)c <br />1. I Type of organization (corporation, pazmersMp, etc.): <br />2. Oceration name (pit, mine or site Dame): <br />3. Permkted acreage (new or eiistine site): <br />3.1 Change in acreage (+) <br />3.2 Total acreage N Yertnit area <br />4. Fees: <br />4.1 New Applicatinn <br />4.2 New Quarry Application <br />4,4 Amendment Fee <br />4.5 Conversion [0 1 12 operation (set by statute) <br />5. Primary commodkle(sl to be roioed; .j`A.h Tit-GL (ze. <br />5.1 Inetidental conunoditie(s) to he mined: I. - Ibs/fons/vr <br />g0 permitted acres <br />~ acres <br />acres <br />$2344.00 application fee <br />$2.906.00 quarry application <br />$1.938.00 amendment fee <br />$2.344.00 conversion fee <br />2. / Ibs/fons/vr <br />3. / IbslCons/vr 4. / Ibs/Cons/vr 5. / Ibs/fons/vr <br />~L 1 i <br />5.2 Anticipated end use of primary commoditie(s) to be mined: C7 L°h ~ ~- a ~ ~/J h,~l"/L ~ fiON `ONCJ'r°~~ <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: <br />OHice of Office of Colorado <br />Mined Land Rexlamation Active and Inactive Mines Ceologicel Survey <br />