2015-07-06_REVISION - M1990057 (3)

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111111111111111111 999 • LIMITED IMPACT OPERATION (110(2)) 56,";-5.702' " APPLICATION FORM !" F ''J The Application for a Limited Impact Operation Reclamation Permit contains X&r'MIJ;0PO parts: (1) the Application Form, (2) the Application Exhibits A -F, and ( )NE T.A(vv application fee. When you submit your Application, be sure to includee�p��„��,� of the Application Form, two copies of Exhibits A -F, and a check for the app Ica on 'tee described under (4) below. To expedite processing, please provide the information in the format and order described in this form. _9v7 IS.Ot7 _m _�=____L1______________ - - GENERAL OPERATION INFORMATION IZT5- Type or print clearly, in the space provided, all information described below. ---------ass=a====_===c=-= 1. Applicant/Operator Name: Leadville Mining & Milling Corp. 2. Operation Name (Pit, mine or site name): - Leoa9d00ifTeSCustom Mill 3. Application type: Limited Impact Operation (110). 4. Application Fee for Permitted Acreage* 8.5 permitted acres. ($10 x (affected acres) + $25.00).* Note permitted acreage and application fee and attach a check for this amount when you file. $115.00 application fee. 5. Substance(s) to be mined (e.g., gold/silver/gravel): gold, silver, lead, zinc. copper, iron 6. Owners(s) of Substance to be Mined (check applicable box(s)): x Private State Federal Indian 7. Owner(s) of Record of Affected Land (check applicable box(s)): X Private State Federal Indian 8. Type of Mining Operation (check applicable box(s)): Surface X Underground In-situ 9. Location Information. The center of the area where the majority of mining will occur lies i n: MINE COUNTY: Lake PRINCIPLE MERIDIANc eck one)- xx 6th (Colorado) 10th (New Mexico) Ute ' TOWNSHIP (write number and check direction): T 9 North X South RA11GE (write number and check direction): R 79 East X West SECTION (write number): S 20 -' QUARTER SECTION ( check one) : -W— NW x SE SW QUARTER/QUARTER SECTION (check one): — NE NW x SE SW GENERAL DESCRIPTION: _— (miles and direction 3.3 miles east from 5th St. & Harrison from nearest town and approximate elevation) Ave., Leadville, co. Elevation: 10,56a Ft. * If the operator is a unit of State or county government, an application fee is not required. A fraction of an acre must be counted as one acre for fee calculation.