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i ~ ~ _.~ _. 1~wr~ / /J~ S/D r1G~~~ 1~'~~ REGULAR (-11.12) PERMIT (VOV 291999 APPLICATION FORM MINED ll1RD This form contains two major parts: (1) General Operation Informa~ion~a~~dT(Z ~ Exh~ b~~ts~ A-P. When you submit your application, be sure to include four signed copies of the General Operation Information, four copies of Exhibits A-P, and aleck for the application fee described under (4) below: To expedite processing, please provide the information in the format and order described in this form. GENERAL OPERATION INFORMATION Type or print clearly, in the space provided, all information described below. 1. Applicant/Operator Name: / 7 P c i s i m, //~~~ 2 S f S~I~~Vur ~~~ ~~+-c , 2. Operation Name (Pit; mine or site name): (rlee~P v !; f 77 - /S / 3. Application type: Regular (112) Permit Operation. 4. Application Fee for Permitted Acreage* / 7 rj permitted ac res. (550.00 + E15.OO/acre, 1st. 50 acres; 7so r s e =,roo zoo E1 O.OO/acre, 2nd. 50 acres; 55.00/acre, 3rd. 50 acres; ,goo E1.OO/acre, any additional acreage; maximum fee of Note permitted acreage and application fee and ,~V ty attach a check for this amount when you file. ~x application fee. 5. Substance(s) to be mined (e. g:; gold/silver/gravel): _-a YY] ,~ p 6. 7. 8. 9. Owners(s) of Substance to be Mined (check applicable box(s)): Private Owner(s) of Record of Affected Land (check applicable box(s)): Private Type of Mining Operation (check applicable box(s)): ~urface State _ Federal _ Indian _ State _ Federal _ Indian _ Underground - In-situ location Information. The center of the area where the majority of mining will occur lies in: COUNTY: 2/~ PRINCIPLE c iec c one 6~' th (Colorado) , TOWNSHIP (write number and check direction): T RANGE (write number and check direction): R SECTION (write number): S 3 QUARTER SECTION (check one): iTN QUARTER/QUARTER SECTION (check one): _ NE GENERAL DESCRIPTION: (miles and direction from nearest town and ` approximate elevation) ~pp, e/vJ~ ~~~ ,,~ p,rf 10th (New Mexico) Ute cTJorth South East /West * If the operator is a unit of State or county government, an application fee is required. A fraction of an acre must be counted as one acre for fee calculation. 1 _ NW SE _ SW NW - SE SW