2013-07-26_PERMIT FILE - M2012052 (5)

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-3- 8. Name of owner of the subsurface rights of affected land: Providence Mining, LLC and Rocky Mountain Gold Innovations, Inc ,Robert M Denis 9. Name of owner of the surface of affected land: Providence Mining, LLC and Rocky Mountain Gold Innovations, Inc, Robert M Denis 10 LOCATION INFORMATION: The center of the area where the majority of mining will occur: COUNTY: Teller PRINCIPAL MERIDIAN (check one): 11 6th (Colorado) ® 10th (New Mexico) ® Ute SECTION (write number): S 18 TOWNSHIP (write number and check direction): T 15 North ' South RANGE (write number and check direction): R 69 East ' West QUARTER SECTION (check one): M NE _a NW M SE F7 SW QUARTER/QUARTER SECTION (check one): r7 NE M1 NW F1 SE F7 SW GENERAL DESCRIPTION: (the number of miles and direction from the nearest town and the approximate elevation) One -half mile northeast of the town of Cripple Creek at an average elevation of 9,850 feet H. Primary Mine Entrance Location (report in either Latitude /Longitude OR UTM): Latitude /Longitude: Example: (N) 390 44' 12.98" (W) 104° 59' 3.87" Latitude (N): deg 38 min 45 sec 19 20 (2 decimal places) Longitude (W): deg 105 min 09 sec 49 oo (2 decimal places) OR Example: (N) 39.736910 (W) - 104.98449° Latitude (N) (5 decimal places) Longitude (W) - (5 decimal places) OR Universal Tranverse Mercator (UTM) Example: 201336.3 E NAD27 Zone 13 4398351.2 N UTM Datum (specify NAD27, NAD83 or WGS 84) Nad 83 Zone 13 Easting Northing 12. Primar "future Post -minin " land use check one): RCropland(CR) Pastureland(PL) General Agriculture(GA) Rangeland(RL) Forestry(FR) Wildlife Habitat(WL) RResidential(RS) Recreation(RC) Industrial /Commercial(IC) Developed Water Resources(WR) RSolid Waste Disposal(WD) 13. Primary resent" land use check one): Cropland(CR) ❑ Pastureland(PL) ® General Agriculture(GA) Rangeland(RL) Forestry(FR) Wildlife Habitat(WL) Residential(RS) Recreation(RC) Industrial/Commercial(IC) Developed Water Resources (WR) ✓ Mining (MN)