2017-04-10_PERMIT FILE - M1980244

• Permit No: M1980244
• IBM Index Class Name: Permit File
• Doc Date: 4/10/2017
• Doc Name Note: Application for a proposed Map Change to CCMOD
• Doc Name: Permit Document
• From: Newmont / CC&V
• To: DRMS
• Email Name: TC1
• Media Type: D
• Archive: No

(10-08-2009)
Name:
AUTHORIZED AGENT - IF DIFFERENT FROM PROPERTY OWNER
See Attached Letter
Mailing Address:
Cripple Creek & Victor Gold Mining Co., P.O. Box 191, Victor, CO 80600
Phone: Office: (719) 689- 4156 Home:
Fax: [phone] Email:
X WRITTEN, NOTARIZED, AUTHORIZATION AND CONSENT FROM ALL PROPERTY OWNERS FOR
AUTHORIZED AGENT TO ACT ON THEIR BEHALF
NOTE: ALL CORRESPONDENCE REGARDING THIS APPLICATION WILL BE ADDRESSED TO THE
AUTHORIZED AGENT/REPRESENTATIVE UNLESS OTHERWISE REQUESTED.
Name: Foresight West Land Surveying Inc.
Mailing Address: 12424 East Weaver Place, Suite 100, Englewood, CO 80111
Phone: Office: [phone]
Fax: [phone]
Home:
Email [e-mail]
I- - ENGINEER (please print) -
Name: Les Ludeman, P.E., Foresight West Land Surveying, Inc.
Mailing Address: 12424 East Weaver Place, Suite 100, Englewood, CO 80111
Phone: Office: 3035044440 Home:
Fax:
[phone]
Legal Description of Property:
❑ If Subdivision, name:
Lot Block
Email: [e-mail]
See Attachment 2.
Filing Tract
❑ If Metes and Bounds: Section Township Range OR Attach a legal
description and survey depicting the property boundary.
L1 If Mining Claim(s), include name(s) and Mineral Survey Number(s):
Street Address:
Assessor's Tax Parcel Identification No(s) (PID): See Attachment 3
NOTE: IF LESS THAN THE ENTIRE PROPERTY IS THE SUBJECT OF THIS APPLICATION, ALSO
ATTACH A LEGAL DESCRIPTION OF THAT PORTION AFFECTED.
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