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1 <br />III III'I~II~II~~ III <br />999 <br />DIVISION OF MINERALS AND GEOLOGY <br />Depdnmem of Natural Resources <br />III 3 Sherman 51., Ruum 215 <br />Denver, Colorado H(1203 <br />Phnnc 11011 H6G-)567 <br />FA% 14031832~810G <br /> <br />STATE OF COLORADO <br />ECEIV <br />SEp 4 01996 <br />Urb~ <br />DEPARTMENT OF <br />NATURAL <br />v RESOURCES <br />Ruy Romer <br />Gwemor <br />lames 5. Lochhe.ul <br />&ec ulmc Di n•c lnr <br />nLr h,rr8 Lonl; <br />U iv rsiun Dueaur <br />(Rule 1.10) <br />CONSTRUCTION MATERIALS ERA<J d l7C Ul <br />REGULAR OPERATION (112) <br />RECLAMATION PERMIT APPLICATION FORM <br />CHECK ONE: New Application (Rule 1.4.5) ~~ Amendment Applicat <br />Conversion Application (Rule 1.11) <br />Permit { ~-~~- 134 - (provide for Amendments land Conversions of <br />existing permits) <br />The application for a Regular 112 Operation Reclamation Permit contains t'. <br />the application form; (2) Exhibits A-S, Addendum 1, any sections of Exhit <br />Stability Exhibit; and (3) the application fee. when you submit your ap) <br />include one (1) complete sieved and notarized IVORY ORIGINAL and four (4) cc <br />ivory application form, five (5) copies of Exhibits A-S, Addendum 1, approp <br />(Geotechnical Stability Exhibit, and a check for the application fee descri <br />below. Exhibits should not be bound or in a 3-ring binder; maps should be 1 <br />or 8 1/2" X 14" size. To expedite processing, please provide the informat <br />order described in this form. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly in the space provided the information requE <br />1. Applicant/operator or company name' (name to be used on permit): <br />1.1 Type of organization (corporation, partnership, etc.): <br />1.2 I.R.S. Tax I.D. No. or Social Security Number: <br />2. Operation name (pit, mine or site name): RANDY SHAW P <br />3. Permitted acreage (new or existing site) <br />3.1 Change in acreage (+ or -) <br />3.2 Total acreage in Permit area <br />4. Fees• <br />4.1 New Application <br />4.2 New Quarry Application ~ <br />4.3 Milling Application (Non-DMO) <br />4.4 Amendment Fee <br />4.5 Conversion to 112 operation (set by statute) <br />ree major parts: (1) <br />.t 6.5 (Geotechnical <br />.ication, be sure to <br />lies of the completed <br />iate sections of 6.5 <br />ed under Section (4) <br />11ded to 8 1/2" X 11" <br />on in the format and <br />below. <br />5. Primary commodit ie( s1 to be mined: SA ND rpnVFT. <br />5.1 Incidental commoditie(s) to be mined: 1. - 10,000 <br /> 2. / lbs /Tons/vr 3. / <br /> 4. / lbs /Tons/vr 5. / <br />5.2 Anticipated end use of primary commoditie(s) to be mined: R <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: <br />permitted acres <br />acres <br />acres <br />~0 application fee <br />. quarry application <br />milling application <br />~. 00 amendment fee <br />00 conversion fee <br />STRUCTION <br />MATERIAL <br />