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<br />-z- <br />3. Address and Phune iJumoer of 29075 County Road No. 331, <br />Local Offices Buena Vista, CO. 81211 <br />(303)-395-2555 <br />4. Address and Phone Number of 29075 County Road No. 331, <br />General Uffices Buena Vista, CO. 81211 <br />(303)-395-2555 <br />5. Name and Phone Number of Verson Roy L. Wright <br />Staff idemoers Should (:ontact Wright Engineering <br />(303-395-6660 <br />6. Owner(s) of Record of Affected Land Randall Champion <br />(surface area) (If more than 2, list below) 26000 U.S. Highway No. 285, <br />Buena Vista, CO. 81211 <br />7. Owner(s) of Substance to be Mined Randall Champion <br />(If more than 2, list below) 26000 U.S. Highway No. 285, <br />Buena Vista, CO. 81211 <br />B. Source of Legal Right-To-Enter <br />(Indicate what type of proof is <br />included in EXHIBIT G - lease, <br />deed, notarized letter, etc.) <br />Mining Lease and Notarized Letter <br />(attached with application) <br />y. Type of Mine and Substance to be Mined Gold Placer Mining with recovery <br />(Specify underyround, open pit, and stockpiling of aggregates. <br />quarry, etc. & suostance(s) to <br />ue mined) <br />lu. General Location and Elevation <br />(Miles s direction from nearest <br />tuwn & approximate site elevation) <br />11. county <br />Southeast of Buena <br />One-Quarter(') mile East <br />No. 285. <br />to 7760. <br />1Z. Acreage of Affected Lands <br />(Total surface acreage to be <br />included in permit) <br />Three(3) miles <br />Vista, CO. and <br />of U.S. Highway <br />Elevation 7780 <br />Chaffee <br />g,o3 <br />13. Application Fee (See applicaole <br />Rule to Betznnine amount) $125.00 <br />