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1111111111111111111 <br />999 <br />• <br />LIMITED IMPACT OPERATION (110(2) ) <br />APPLICATION FORM <br />The Application for a Limited Impact Operation Reclamation Permit contains t 4-'M'aj00 <br />parts: (1) the Application Form, (2) the Application Exhibits A -F, and (A)NE Af'4W <br />application fee. When you submit your Application, be sure to includes �� �,��1 <br />of the Application Form, two copies of Exhibits A -F, and a check for the app lca on'fee� <br />described under (4) below. To expedite processing, please provide the information in <br />the format and order described in this form. -m _9� ;�7��-- Lf5.OZ7 <br />___ ___ ==_ <br />GENERAL OPERATION INFORMATION i lalo9 - <br />Type or print clearly, in the space provided, all information described below. <br />1. Applicant/Operator Name: Leadville Mining & Milling Corp. <br />2. Operation Name (Pit, mine or site name): Nii_7 - LeoademofTes ustom Mill <br />3. Application type: Limited Impact Operation (110). <br />4. Application Fee for Permitted Acreage* <br />($10 x (affected acres) + $25.00).* <br />Note permitted acreage and application fee and <br />attach a check for this amount when you file. <br />8,5 permitted acres. <br />$115.00 <br />application fee. <br />5. <br />Substance(s) to be mined (e.g., gold/silver/gravel): <br />gold, silver, lead, zinc. <br />copper, iron <br />6. <br />Owners(s) of Substance to be Mined <br />(check applicable box(s)): X Private <br />_ State Federal Indian <br />7. <br />Owner(s) of Record of Affected Land <br />(check applicable box(s)): X Private <br />_ State ' Federal _ Indian <br />8. <br />Type of Mining Operation <br />(check applicable box(s)): _ Surface X Underground _ In-situ <br />9. <br />Location Information. The center of the area where <br />the majority of mining will <br />occur lies i n: MINE <br />COUNTY: Lake <br />PRINCIPLE MERIDIANc eck one): xx 6th (Colorado) 10th (New Mexico) Ute <br />TOWNSHIP (write number and check direction): <br />T 9North X South <br />RANGE (write number and check direction): <br />_ <br />R 79 East X West <br />SECTION (write number): <br />S 20 — -' <br />QUARTER SECTION ( check one) : <br />NW x SE SW <br />QUARTER/QUARTER SECTION (check one): <br />_-TVA _ _ <br />NE NW x SE SW <br />GENERAL DESCRIPTION: <br />_ _ <br />(miles and direction 3.3 miles east from 5th St. & Harrison <br />from nearest town and <br />approximate elevation) Ave., Leadville, CO. Elevation: 10,56a Ft. <br />* If the operator is a unit of State or county government, an application fee is not <br />required. A fraction of an acre must be counted as one acre for fee calculation. <br />