2008-12-19_REVISION - M1980244 ‎(9)‎

• Permit No: M1980244
• IBM Index Class Name: REVISION
• Doc Date: 12/19/2008
• Doc Name: Land Use Appl Formm
• From: CC&V
• To: DRMS
• Type & Sequence: TR53
• Media Type: D
• Archive: No

•
APPLICANT - IF DIFFERENT THAN PROPERTY OWNER (please print)
Name: Cripple Creek & Victor Gold Mining Company
Mailing Address: PO Box 191
Victor, Colorado 80860
Phone OFFICE: [phone] HOME:
FAX: [phone] e-mail gqoodrichla-anglogoldashantina.com
CC&V is Applicant and Property Owner through ownership, leases, and other agreements. CC&V has
Right to Enter and Mine for all properties within the permit boundary. See Attachment 2 Mining
Development Plan Amendment for Mine Life Extension April 2008 (Volume 1)
ATTACHED: WRITTEN, NOTARIZED, AUTHORIZATION AND CONSENT FROM ALL
PROPERTY OWNERS FOR APPLICANT TO SUBMIT THIS APPLICATION
AUTHORIZED AGENT or REPRESENTATIVE - IF DIFFERENT THAN PROPERTY OWNER
(please print)
•
Name: Cripple Creek & Victor Gold Mining Company
Mailing Address: PO Box 191
Victor, Colorado 80860
Phone OFFICE: [phone] HOME:
FAX: [phone] e-mail ggoodrichO-anglogoldashantina.com
ATTACHED: 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 or
Representative UNLESS otherwise requested.
SURVEYOR (please print)
Name: Mike Lust, Foresight West Land Surveying Inc.
Mailing Address: 12424 east Weaver Place, Suite 100
Englewood, Colorado 80111
Phone OFFICE: [phone] HOME:
FAX: [phone] a-mail
ENGINEER (please print)
Name: Please refer to individual reports included as Appendices in DRMS Application, Mine Life
Extension April 2008 Volumes I-VII
Mailing Address: Address and Contact Information as above
Phone OFFICE: HOME:
FAX: e-mail
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