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III IIIIIIIIIIIII III ~ <br />DIVISION OF MINERALS AND GEOLOGY <br />Department of Natural Resources <br />1313 Sherman St., Room 215 <br />Denver, Colorado 80203 <br />Phone: 13031 866-3567 <br />FAX: (303) 832-8106 <br />• <br />STATE OF COLORADO <br />C <br />7/a % RECEIVED <br />JUL 2 ~ 1997 <br />CONSTRIICTION NATSRIALS {~ <br />LIMITED I16~ACT OPBRATION DIQi110r? Of <br />PBRMIT APPLICATION FORM <br /> <br />CHECK ONE: ~_ Ner Application (Rule 1.4) Amandmrat <br />Coavarsioa Application (Rule 1.11) <br />Permit # - -_ <br />The application for a Construction Materials ij <br />Permit contains three major parts: (11 the aT <br />Addendum 1, any sections of Exhibit 6.5 and Ge <br />Office, and outlined in Rules 6.1, 6.2, 6.3, <br />submit your application, be sure to inclu a one <br />and one (1) copy of the completed ivor pli <br />Exhibit L, appropr to sections of 6.5 (Geo cYu <br />for the applica on described under (4) <br />binder; maps ould be folded to 8 1/2^ X 1 <br />please provid the info tion in the forma a1 <br />._~____-__~~.~=__s==a <br />Type print <br />1. A licant o erato <br />e <br />1.1 Type ox <br />1.2 I.R.S. <br />GENERAL OP <br />rly, in the space <br />DEPARTMENT' OF <br />Roy Romer <br />Governor <br />lames 5. L"chhead <br />Executive DirMOr <br />Michael B. Long <br />Division Dimctor <br />S. 34-32.5-110) <br />(provide for as eats and Convereioas of <br />'sting permit <br />nit Imps M ning (110) Operation Reclamation <br />Mica ion (2) Exhibits A-J and Exhibit L, <br />ec 'cal ability Exhibit, as required by the <br />n 6. a (3) the application fee. When you <br />(1 c 1 e si ed and notarized IVORY ORIGINAL <br />;tio fo two (2) copies of Exhibits A-J and <br />ility Exhibit), as required, and a check <br />ibits should NOT be bound or in a 3-ring <br />1/2" X 14" size. To expedite processing, <br />der-described-in-thsisf=rnt- zi= Lss ~ <br />~I _C~ ~ =h~=~ <br />all information described below. <br />n ermit <br />ID No. <br />rtners~i'ip, etc.) : c <br />Number: ~a7-31~- <br /> <br />2. Ooeration name (p' mine or sit name) : AQr1 '-C AL ~` 1 <br /> <br />3. Permitted acreage w or existing site): ~(7 _ permitted acres <br /> 3.1 Change in ac age (+ or -) ~ o- acres <br /> Total Acreag in Permit Area ~E}- acres <br />4. Fees• <br /> 4.1 New Application S875.00 application fee <br /> Amendment Fee (C.R.S. 34-32.5-125(II)) 5575.00 application fee <br /> 4.2 Conversion Fee (from 110d to 110 875.00 conversion fee (Rule 1.11.2(2)) <br />5. Primary commoditie(s) to be mined: ~U~ <br /> 5.1 Incidental commoditie(s) to be mined: 1. lbs/Tons/vr <br /> 2. / lbs/Tons/vr 3. / lbs/Tons/vr <br /> 4. / lbs/Tons/vr 5. lbs Tons <br /> 5.2 Anticipated end use of primary commoditie(s) to be mined: ~ (j <br /> 5.3 Anticipated end use of incidental commoditie (s) to be mined: N A <br /> <br />