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IMIT: III IIIIIIIIIIIII III i (lltl) <br />APPLICATION FORM <br />CHECKONEf C New Application tRule i.4j _ConvmtonAppbceLOn (Rule l.lt) <br />Pertnu k M ~ _,- (provide for converstons of erdsting permits) <br />4ECEIVED <br />MAY 0 3 1995 <br />Division of Minerals 8 Geology <br />ltte application for a l.imiled Impact Designated Mining Operation Reclamation Permit conteina three major parts. (.,I) the <br />application fonn~, (2) Exhibits A~J, any required actions of Exhibit S and Geotechnical Stability Exh:biL as required by the <br />Uffice, and outlined in Rules 6.1, ti.2, 6.4.19 and 6.5; and (3) the appbcation fee. When you submit your application, be sure <br />to include one (1) si¢ned and rtotanzed original and one (1) copy of the application form, two (2) copies of Exhibits A-1, <br />appropriate secAOns ot'6.4.1a Extubrt 5 and o S (Geotechnice! Stability ExJnbit), as required, and a check Cm the application <br />fee described under (4) below. Exhibits should not be bound or in a 3-ring binder, maps should be folded to 8 I/2" x I I" or S <br />I/." x I e' atu. To expedite processing, please provide the infntmetion W the format end ordm described in thra form. <br />GENERAL OPERATION PIFORtitATION <br />'T'YF+c w y~uil dculr, u~ des ayacc ywvnlcQ all udvuna4vu Jca~uLcal Lcluw <br />1. AVplicutdopuaror ur wmpuiy ,w:u (nvuc to be mcd un pemtit), <br />I.1 Type oCorgaruuoon (corponnon, pertrrcrdup, etc.>: Cxyantlon <br />1 2 IR9 71u ID Nu. ur S[icinl Sa;wi[y NwuLcr. e~lOS13)7 <br />2 Opemtion name (piL mute, or site name)' Gold Hill MIII <br />3. Paurittcd aueagc (uew w cnutuy(ou.c). ~~ pemnt4d aces <br />3.l Change to acreage (* Ot •): acres <br />4. Fees <br />4 I New Application 5875.00 apptieotion Cee <br />1.2 Conversion Fa (from 1 tOd tc 110) }575.00 convemran fee (Rule I .l l.2(2)) <br />S Primary commodity (lee) to be mined: (',old Suva , --.. <br />6. Nome of owner to the subsurface rights of affected lend: Q.O.M. Lac. <br />7 Neme of owner to the surface of affected land• C.O.M. Ina. <br />R. Type of rttinittg opera4on: X Surfea W Underground _In•situ (Mllllo~ <br />9 Location information. The center of the Brea where the me)ority of mu»rtg will ocna lies in: <br />COUNTY Boulder <br />PRINCIPAL MERIDIAN (check one): . X 6th iColoradol 10th Mew Mexico) Ute <br />SECTION (write number): S 12- <br />TOWNSHIP twrtte number and check direction): T 1 k North _ South <br />RANGE (write nttmber end check directiont: R ~ Past ~ Wear <br />QUARTER SECTION (check one): _ NE _7C NW SE _ SW <br />QL'ARTER/QUARTER SECI'tON (check one): _ NE IJl1' X SE SW <br />GENERAL DESCR1Pt ION: (miles and dvection Gom neazeat town end apprmdtnete elevetlon). <br />p,Z90 fiat elevapm. f0 rol4s_wrrt of Houre.r_ r'n_ Fleratloe 8550 b 86D0 feat <br />