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~n-aoa~-a s~7/ <br />STATE OF <br />Di VISION OF MINERALS AND GEOLOGY RECEIVED <br />Department of Natural Resources <br />1373 Sherman St, Room 275 JU~ q ~ q~~ ~/ <br />Denver, Colorado 80203 G L D t v t s t O N o f <br />Phone: (303) 866-3567 MINERAL $ <br />FAX: (303) 832-81 pb Division 1f Minerals and Ga0(a~y & <br />GEOLOGY <br />CONSTRUCTION MATERIALS tc E c t. A M A r i o N <br />MINING•SA FETY <br />REGULAR (112) OPERATION ~~ <br />RECLAMATION PERMIT APPLICATION FORM Bill Owens <br />Governor <br />Greg E. Walther <br />Executive Director <br />?CK ONE: X New Application (Rule 1.4.5) ~ Amendment Application (Rule 2.1Q~ichae! B. Long <br />Division Director <br />Conversion Application (Rule 1.11) <br />Permit # 4 -~y~'L-_ (provide for Amendments and Conversions of existing permits) <br />The application for a Construction Ivlateaials Regular 112 Operation Reclamation Permit contains three major pazts: (1) the application form; <br />(2) Exhibits A-S, Addendum I, any sections of Exhibit 6.5 (Geotechnical StabilityExhibit; and (3) the application fee. When you submit your <br />applicafion, be sure to include one (1) complete sieved and notarized IVORY ORIGINAL and fotn (4) copies of the completed Ivorv <br />application farm, five (5) copies of Exhibits A-S, Addendum 1, appropriate secfions of 6.5 (Geotechnical Stability E~c}7ibit, and a check for the . <br />applicator fee described under Section (4) below. Exhibits should NOT be bound or in a 3-ring binder; traps should be folded to 8 1/2" X 11" <br />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 IIv'FOItMATION <br />Type or print cleazly, in the space provided, ALL information requested below. <br />1. Applicantloperator or company name (name to be used on permit): FARFRUMWURKIN , LLLP / <br />I.1 Type of organization (corporation, partnership, etc,): LLLP <br />1.2 I.R.S. Tax I.D. No. or Social SecttriryNumber: _ <br />2. Operation name (pit, mine of site name): FILE PIT 112 <br />~. Permitted acreaee (new oc etdstine site]: ~ ~ permitted acres <br />3.1 Change in acreage (+) <br />3.2 Total acreage in Permit azea <br />4. Fees: <br />4.1 New Application <br />4.2 New Quarry Application <br />4.4 Amendment Pee <br />4.5 Conversion to 112 operaflon (set by statute) <br />5. Primary commrtditie(sl to be mined: SAND GRAVEL ROCK <br />5.1 Incidental commoditie(s) to be mined: 1. - ]bs/I'ons/vr <br />acres <br />aCIeS <br />$2.344 00 application fee <br />$2.906.00 quarry application <br />$1.938.00 amendment fee <br />$2.344.00 conversion fee <br />2. / lbs/I'ons/vr <br />3. / 1bsrTons/vr 4. / Ibs/fons/vr 5. / Ibs/Fons/vr <br />5.2 Anticipated end use of primazy cotnmodifle(s) to be mined: CONSTRUCTION MATERIALS <br />5.3 Anticipated end use of incidental commodifle(s) to be trained: <br />