Form YG5042 "Grouping Work Program" - Yukon, Canada

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Placer grouping number __________________________
PLACER MINING ACT SECTION 52(2)
GROUPING WORK PROGRAM
Submit to district mining recorder. A sketch must accompany this application outlining all claims included.
Office date stamp
Mining district:
Dawson
Mayo
Watson Lake
Whitehorse
Status:
New
Amended work program
Applicant’s name
Agent for
Approval of a grouping does not grant authority to carry out activities, renew, or
common date claims listed on the application. Contact the Mining Recorder’s Office
for further information on required permits and approvals before beginning any
work on your claims.
Applications for grouping claims which are non-adjoining or exceed ten in number must show a system of mining that
has a direct bearing on all other claims affected and renders a considerable area necessary to successful operation by
the system proposed. Applicants are responsible for updating their work program as changes are made.
1. Are all of the claims contained within this application a part of a valid water licence, or an approved class 3 Mining
Land Use Approval operating plan?
Yes*
No
* If yes, do not complete questions 4 through 6.
Y Y Y Y
/
M M
/
D D
If yes: Mining Land Use Approval number: _________________________
Expiry date: ________________________
Y Y Y Y
/
M M
/
D D
Water licence number: ____________________________________
Expiry date: ________________________
2. Do any of the claims overlap with settlement land?
Yes
No
If yes: Indicate all First Nations: __________________________________________________________________________
Indicate all parcel codes: __________________________________________________________________________
Are you planning to conduct work on any claims overlapping settlement land?
Yes
No
N/A
If yes, describe the work that will be conducted (i.e. dimensions and total number of trenches, total
number of drill holes), time frames, and identify all planned locations on an attached sketch, if this work
is not already included in a license or permit: __________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
3. If the claims are not contiguous, what is the approximate distance between blocks?
__________ km
N/A
Note: Identify all planned or potential locations for exploration work on an attached sketch/map.
Attach additional pages/information as needed.
4. Sketch of current, planned or proposed work/exploration activities is attached to this application.
Yes
5. Could work occur anywhere on the claims depending on exploration results?
Yes
No
6. Indicate the type of work that may occur on the claims (check all that apply).
Stripping and mining by mechanical means
Test pits or trenching by mechanical means
Drilling
Geophysics
Hand shoveling
Hand shafting
Hand drifting
Road maintenance/trail building (all road building on claims or off claims must have valid permits in place)
Other (specify): ______________________________________________________________________________________
7. Provide any additional information that may be relevant to your proposed placer grouping (attach additional pages as necessary):
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
Read carefully:
By signing below, the applicant is acknowledging that they understand that this application does not constitute
authority to commence any work program on the ground, and when, and if the grouping is granted pursuant to the
Placer Mining Act, they agree to be bound by the terms and conditions contained therein. In particular, the applicant
is aware they shall comply with:
a) the provisions of the Placer Mining Act, Placer Mining Land Use Regulation, and all other other applicable
legislation including but not limited to the Waters Act, the Fisheries Act, the Territorial Mine Safety Act, the Yukon
Surface Rights Board Act, the Territorial Lands Act, and all regulations and Orders made pursuant thereto; and
b) the Umbrella Final Agreement, and any applicable Yukon First Nations Final Agreements.
Applicant/agent signature: ________________________________________________
Date: ________________________
OFFICE
Mining recorder signature
Total # of claims in grouping
Approved
USE ONLY
Refused as per section 52(2) PMA
Access to Information and Protection of Privacy Act: I understand this information is being collected under the authority of sections 7, 9 and 52(2) of the Placer Mining Act and
section 29(c) Access to Information and Protection of Privacy Act for the purpose of reviewing applications for the grouping of placer claims. This document may be made available
to the public. For further information, contact the Department of Energy, Mines and Resources, Mining Lands Office at 867-667-3190 or toll free at 1-800-661-0408 extension 3190.
YG(5042EQ)F1 Rev.02/2019
Print
Clear
Placer grouping number __________________________
PLACER MINING ACT SECTION 52(2)
GROUPING WORK PROGRAM
Submit to district mining recorder. A sketch must accompany this application outlining all claims included.
Office date stamp
Mining district:
Dawson
Mayo
Watson Lake
Whitehorse
Status:
New
Amended work program
Applicant’s name
Agent for
Approval of a grouping does not grant authority to carry out activities, renew, or
common date claims listed on the application. Contact the Mining Recorder’s Office
for further information on required permits and approvals before beginning any
work on your claims.
Applications for grouping claims which are non-adjoining or exceed ten in number must show a system of mining that
has a direct bearing on all other claims affected and renders a considerable area necessary to successful operation by
the system proposed. Applicants are responsible for updating their work program as changes are made.
1. Are all of the claims contained within this application a part of a valid water licence, or an approved class 3 Mining
Land Use Approval operating plan?
Yes*
No
* If yes, do not complete questions 4 through 6.
Y Y Y Y
/
M M
/
D D
If yes: Mining Land Use Approval number: _________________________
Expiry date: ________________________
Y Y Y Y
/
M M
/
D D
Water licence number: ____________________________________
Expiry date: ________________________
2. Do any of the claims overlap with settlement land?
Yes
No
If yes: Indicate all First Nations: __________________________________________________________________________
Indicate all parcel codes: __________________________________________________________________________
Are you planning to conduct work on any claims overlapping settlement land?
Yes
No
N/A
If yes, describe the work that will be conducted (i.e. dimensions and total number of trenches, total
number of drill holes), time frames, and identify all planned locations on an attached sketch, if this work
is not already included in a license or permit: __________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
3. If the claims are not contiguous, what is the approximate distance between blocks?
__________ km
N/A
Note: Identify all planned or potential locations for exploration work on an attached sketch/map.
Attach additional pages/information as needed.
4. Sketch of current, planned or proposed work/exploration activities is attached to this application.
Yes
5. Could work occur anywhere on the claims depending on exploration results?
Yes
No
6. Indicate the type of work that may occur on the claims (check all that apply).
Stripping and mining by mechanical means
Test pits or trenching by mechanical means
Drilling
Geophysics
Hand shoveling
Hand shafting
Hand drifting
Road maintenance/trail building (all road building on claims or off claims must have valid permits in place)
Other (specify): ______________________________________________________________________________________
7. Provide any additional information that may be relevant to your proposed placer grouping (attach additional pages as necessary):
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
Read carefully:
By signing below, the applicant is acknowledging that they understand that this application does not constitute
authority to commence any work program on the ground, and when, and if the grouping is granted pursuant to the
Placer Mining Act, they agree to be bound by the terms and conditions contained therein. In particular, the applicant
is aware they shall comply with:
a) the provisions of the Placer Mining Act, Placer Mining Land Use Regulation, and all other other applicable
legislation including but not limited to the Waters Act, the Fisheries Act, the Territorial Mine Safety Act, the Yukon
Surface Rights Board Act, the Territorial Lands Act, and all regulations and Orders made pursuant thereto; and
b) the Umbrella Final Agreement, and any applicable Yukon First Nations Final Agreements.
Applicant/agent signature: ________________________________________________
Date: ________________________
OFFICE
Mining recorder signature
Total # of claims in grouping
Approved
USE ONLY
Refused as per section 52(2) PMA
Access to Information and Protection of Privacy Act: I understand this information is being collected under the authority of sections 7, 9 and 52(2) of the Placer Mining Act and
section 29(c) Access to Information and Protection of Privacy Act for the purpose of reviewing applications for the grouping of placer claims. This document may be made available
to the public. For further information, contact the Department of Energy, Mines and Resources, Mining Lands Office at 867-667-3190 or toll free at 1-800-661-0408 extension 3190.
YG(5042EQ)F1 Rev.02/2019
Print
Clear