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N iii iiiiiiiiiiiiiiii M _, TWO-ACRE LIMITED IMPACT OPERATION (110(1)) MAY 1 4 1991 RECLAMATION PERMIT APPLICATION FORM ?Jli~ied rand RE~'~~~'`i~- tlUi l OIVISIOR The application fora Two-Acre Limited Impact Operation Reclamation Permit shall contain three major parts: (1) the application form, (2) Exhibits A-H, and (3) the application fee. '+Jhen you submit your application, be sure to include two (2) signed copies of the application form, two (2) copies of Exhibits A-H, and a check for a app ication fee described under (3) below. To expedite processing, please provide the information in the formal and order described in this form. 5 g ______________________________________________m q1==5 -____~=~'=J5 ==Z' ___= ys ~~ GENERAL OPERATION INFORMATION Type or print clearly, in the space provided, all information described below. 1. Applicant/operator name: Indian Creek Mining Corporation 1.1 Type of organization (corporation, partnership, etc.) Corporation 2. Operation Name (pit, mine or site name): Proffitt 2.1 IRS Tax ID No. or Social Sea rity No.: 3. Application fee for permitted acreage: Less than 2 acres permitted acres (525 + 510/acre)* Note permitted acreage and application fee and attach a check for this amount when you file. $45.00 application fee 4. Substance(s) to be mined (e .g ., gold/silver): Gold/Silver 5. Name, address, and phone number of the owner of the surface of the affected land: Lewis J. Allen Estate of Lo an Allen - Berniece Macklin P.O. Box 13 S C 8 201-01 - 719 539-6606. 6. Name of owner of subsurface rights of affected lands: Lewis J. Allen. Estat of oaanen 7. Type of mining operation: _ Surface XUnderground _ In-situ 8. Location Information. The center of the area where the majority of mining will occur lies in: COUNTY: Saguache PRINCIPAL MERIDIAN (check one): 6th (Colorado) X 10th (New Mexico) Ute TOWNSHIP (write number and check direction): T 47 X North _ South- RANG'c (write number and check direction): R -T ~ East _ West SECTION (write number): S -T5 QUARTER SECTION (check one): X~ NW SE _ SW QUARTER/QUARTER SECTION (check one): -_ NE NW X SE _ SW GENERAL DESCRIPTION: (miles and direction 5 miles NW of Bonanza, CO from nearest town and approximate elevation) 11,800 elevation * A fraction of an acre rtust be counted as one acre for fee calculation. If the operator is a unit of state or county government, an application fee is not required.