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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 />CONSTRUCTION MATERIALS <br />REGULAR (112) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />CHECK ONE: 0 There is a File Number Already Assigned to this Operation <br />20 02 020 Harris D. Sherman <br />P M _ 2 0 _ 0 2 _ 0 2 _ (Please reference the file number currently assigned to this operatioz)ecutive Director <br />New Application (Rule 1.4.5) Amendment Application (Rule 1.10) Ronald W. Cattany <br />0 Conversion Application (Rule 1.11) Naaturatural l N Director <br />Resoruce Trustee <br />Permit # M - 2002 - 020 - (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 />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, ALL information requested below. <br />1. Applicant/operator or company name (name to be used on permit): City of Greeley <br />1.1 Type of organization (corporation, partnership, etc.): Municipality <br />2. Operation name (pit, mine or site name): 25th Avenue Site <br />3. Permitted acreage (new or existing site): <br />3.1 Change in acreage ( +) <br />3.2 Total acreage in Permit area <br />4. Fees: <br />4.1 New Application $2,696.00 <br />4.2 New Quarry Application $3.342.00 <br />4.4 Amendment Fee $2.229.00 <br />4.5 Conversion to 112 operation (set by statute) $2.696.00 <br />5. Primary commoditie(s) to be mined: sand <br />3. / lbs/Tons/vr 4. <br />gravel <br />STATE OF COLORADO <br />tl /a4 l � a <br />A fl-t- <br />89A6 <br />197,51. . <br />286.67 <br />5.1 Incidental commoditie(s) to be mined: 1. nia lbs/Tons/vr 2. / <br />/ <br />lbs/Tons/vr 5. / <br />COLORADO <br />DIVISION OF <br />RECLAMATION <br />MINING <br />— &— <br />SAFETY <br />Bill Ritter, Jr. <br />Governor <br />permitted acres <br />acres <br />acres <br />application fee <br />quarry application <br />amendment fee <br />conversion fee <br />lbs/Tons/vr <br />1bsfrons/vr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: Construction Materials <br />ma <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: nia <br />Office of Office of <br />Denver • Grand Junction • Durango Active and Inactive Mines <br />Mined Land Reclamation <br />