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~Y1-- l ~. c ~-~ ~~ <br />~'~ ~ ~~ <br />STATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />Department of Natural Resources <br />13135herman St., Room 2li - ~ -.RECE!!/ED. <br />Denver, Colorado 60203 <br />Phone: (303) 866-3567 CONSTRUCTION MATERIALS . t/ <br />FAx: (303) e3z-a106 REGULAR (112) OPERATION MAR Q 1{ ZQQ? <br />RECLAMATION PERMTT APPLICATION FORM <br />Division of Minerals and Geology <br />CHECK ONE: There is a File Number Already Assigned to tbis Operation <br />Petmi[ # M -_ _ _ (Please reference the file number currently assigned to this operation) <br />New Application (Rule 1.4.5) <br />Amendment Application (Rule 1.10) <br />Conversion Application (Rule I ) <br />Permit # M - -~~- r (provide for Amendments and Conversions of existing permits) <br />~~ <br />DIVISION O <br />MINERAL <br />&- <br />GEOLOG <br />RE CIA MATIOI <br />MINING•SAFET' <br />Bill Owens <br />Governor <br />Greg E. Walther <br />Executive Director <br />Michael 8. Long <br />Division Director <br />The application fora Construction Materials Regular 112 Qperation Reclamation Pemtit contains three major parts: (1) the application form; <br />(2) Exhibits A-S, Addendum I, any sections of Exhibit 6.5 (Geotechnical Stability Exhrbi[; and (3) the application fee. When you submit your <br />application, be sure to include one (1) complete sieved and notarized IVORY ORIGINAL and four (4) copies of the completed Ivory <br />apphcation form, five (5) copies of Exhibits A-S, Addendum 1, appropriate sections of 6.5 (Geoteclmical Stability Exltibit, and a check for <br />the application fee described under Sectioa (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 thethe information in the format and order described in this form. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, aD information described below. <br />1. <br />A <br />1.1 Type of organization (corporation, partnership, etc.): S~d/'D~O/-/ P7~mi"S`Ii~7 <br />1.2 I.R.S. Tax I.D. No. or Social Security Number: ~ - d9PD5~7/ <br />2. Operation name (pit, mine or site Hamel: lA/~'!EO ~ie/9`~L <br />3. Permitted acrearte (new or existing site): _~~i .55. permitted acres <br />3.1 Change in acreage (+) ~~-~~ '~7 acres <br />3.2 Total acreage in Permit azea ~9J~- ~~ acres <br />4. Fees <br />4.1 New Application $2.344.00 application fee <br />4.2 New Quarry Application 52.906.00 quarry apphcation <br />4.4 Amendment Fee $1.938.00 amendment fee <br />4.5 Conversion to 112 operation (set by statute) $2.344.00 conversion fee <br />5. Prim ary commoditie(s) to be mined: ~ re `/ ra G~D6ls/~'s. <br />5.1 Incidental commoditie(s) to be rained: 1. / lbs/Tons/vr 2. / Ibs/Tons/vr 3. / ]bs/Tons/vr <br /> 4. / ]bs/I'ons/vr 5 . / lbs/Tons/vr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: /'79 GrGJ~ 64Se ~- ~4/IdSCQ~ <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: <br />