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1 <br />1 <br /> <br /> <br />1 <br />1 <br /> <br /> <br /> <br /> <br />~l <br /> <br />1 <br />III IIIIIIIIIIIIIIII <br />~~~~~~~® <br />LIMITED IMPACT OPERATION (110) N aV 2 5 1981 <br />APPLICATION FORM MINED LAND <br />This form Contains two major parts: (1) General Operation Infor~ine~~onAan~D(2 DE hS10Ns <br />A-G. When you submit your application, be sure to include two _si named copies of the <br />General Operation Information, two copies of Exhibits A-G, and a c e k for the <br />application fee described under (4) below. To expedite processing, please provide the <br />information in the format and order described in this form. /,/y/] ~ c]~ <br />.e.ee.eee.o.eee..e..eeeeeeez----------------z--_-----aee=ee! y ~ _~__ ~ ___ <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, all information described below. <br />1. Applicant/Operator Name: NORTHERN MINERALS.INC. <br /> <br />2. Operation Name (Pit, mine or site name): INCAS MINE <br /> <br />3. Application type: Limited Impact Operation (110). <br />4. Application Fee for Permitted Acreage* Amended# permitted acres. <br /> (E10 x (affected acres) + E25.00).* <br /> Note permitted acreage and application fee and *No New Acreage <br /> attach a check for this amount when you file. $0.00 application fee. <br />5. Substance(s) to be mined (e. g., gold/silver/gravel): pU, pu <br /> <br />6. Owners(s) of Substance to be Mined <br /> (check applicable box(s)): ® Private ^ State ^ Federal ^ Indian <br />7. Owner(s) of Record of Affected Land <br /> (check applicable box(s)): ® Private O State ^ Federal ^ Indian <br />8. Type of Mining Operation <br /> (check applicable box(s)): ® Surface ® Underground ^ In-situ <br />9. Location Information. The center of the area where the majority of mining will <br /> occur lies in: <br />COUNTY: LaPlata <br />' PRINCIPLE MER D AN c ec one ~ ® 6th (Colorado) ^ 10th (New Mexico)^ Ute <br />TOWNSHIP (write number and check direction): T ~_ m North ^ South <br />RANGE (write number and check direction): R 1L_ ^ East ® West <br />1 <br /> <br />1 <br /> <br />SECTION (write number): S <br />QUARTER SECTION (check one): ^~ ® NW ^ SE ^ SW <br />QUARTER/QUARTER SECTION (check one): p NE m NW p SE ® SW <br />GENERAL DESCRIPTION: <br />(miles and direction 17 air m;1PC nnrthwPCt of DuraneQ <br />from nearest town and <br />approximate elevation) R1PVar;nn - In 6nn fPPt <br />* If the operator is a unit of State or county government, an application fee is not <br />required. A fraction of an acre must be counted as one acre for fee calculation. <br />J <br />