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DIVISION OF RECLAMATION, MINING AND SAFETY <br />Department of Natural Resources <br />1313 Sherman St., Room 215 <br />Denver, Colorado 80203 <br />Phone: (303) 866.3567 <br />FAX: (303) 832 - 8106 <br />Bill Ritter, Jr. <br />CHECK ONE: El There is a File Number Already Assigned to this Operation Governor <br />1 9 _ 9 2 _ 058 Nanis D. Sherman <br />Pe M - (Please reference the file number cturently assigned to this operat Di rector <br />New Application (Rule 1.4.5) Amendment Application (Rule 1.10) Div W a <br />Conversion Application (Rule 1.11) Natural eResourceTrustee <br />Di ve <br />CONSTRUCTION MATERIALS A, n.,, <br />REGULAR (112) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />Permit # M - 19 - 9 9 - .. J 15 R (provide for Amendments and Conversions of existing permits) <br />The application for a Construction Materials Regular 112 Operation Reclamation Permit contains three major parts: (1) the application <br />form; (2) Exhibits A -S, Addendum 1, any sections of Exhibit 6.5 ( Geotechnical Stability Exhibit; and (3) the application fee. When you <br />submit your application, be sure to include one (1) complete signed and notarized ORIGINAL and one (1) copy of the completed <br />application form, two (2) copies of Exhibits A -S, Addendum 1, appropriate sections of 6.5 (Geotechnical Stability Exhibit, and a check for <br />the application fee described under Section (4) below. Exhibits should NOT be bound or in a 3 -ring binder, maps should be folded to <br />8 1/2" X 11" or 8 1/2" X 14" size. To expedite processing, please provide the information in the format and order described in this form. <br />1. <br />3. Permitted acreage (new or existina site): <br />3.1 Change in acreage (+) <br />3.2 Total acreage in Permit area <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, ALL information requested below. <br />AnDlicant/operator or company name (name to be used on permit): <br />1.1 Type of organization (corporation, partnership, etc.): Cory <br />2. Operation name (pit, mine or site name): Mica White Pit <br />4. Fees: <br />4.1 New Application <br />4.2 New Quarry Application <br />4.4 Amendment Fee <br />4.5 Conversion to 112 operation (set by statute) <br />5. Primary commoditie(s) to be mined: Aquarium and Landscape Stone <br />5.1 Incidental commodities to be mined: 1.Grav <br />O GraVe1 - 2000 lb yr <br />3. / lbs/Tons/yr 4. / lbs/Tons/yr <br />Office of <br />Mined Land Reclamation Denver • Grand Junction • Durango <br />1/1.1 G 1pt L)LV1VL AJ <br />ion <br />C A/0/ <br />f`nlnrarin Quarries, TNC. <br />2. B <br />5. / <br />5.2 Anticipated end use of primary commoditie(s) to be mined: Aquar i um and Landscape S t one <br />COLORADO <br />D I V I S I O N O F <br />RECLAMATION <br />MINING <br />— &— <br />SAFETY <br />9.95 <br />28.15 <br />38.10 <br />$2,696.00 application fee <br />$3,342.00 quarry application <br />52,229.00 amendment fee <br />$2.696.00 conversion fee <br />500 1bs.Ivr <br />lbs/Tons/vr <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: Road Gravel and Landscape Boulders <br />r4K <br />permitted acres <br />acres <br />acres <br />Office of <br />Active and Inactive Mines <br />