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12. Primj future (Post -mining) land use (chec ): <br />ropland(CR) <br />Rangeland(RL) <br />Residential(RS) <br />Developed Water Resources(WR) <br />13. Prim resent land use (check one): <br />Cropland(CR) <br />Rangeland(RL) <br />_ Residential(RS) <br />Developed Water Resources (WR) <br />-4- <br />_ Pastureland(PL) <br />.— Forestry(FR) <br />Recreation(RC) <br />EPastureland(PL) <br />Forestry(FR) <br />ERecreation(RC) <br />General Agriculture(GA) <br />Wildlife Habitat(WL) <br />Industrial/Commercial(IC) <br />Solid Waste Disposal(WD) <br />General Agriculture(GA) <br />ElWildlife Habitat(WL) <br />Industrial/Commercial(IC) <br />Mining (MN) <br />14. If this operation will use designated chemicals, or will result, or presently has acid mine drainage - you cannot use this application <br />form. You must submit either a 110d or 112d application form for Designated Mining Operations. In either case, you must list <br />any acidic or toxic -forming materials, exposed or disturbed as a result of the mining operation, and whether the operation will <br />result in or presently has acid mine drainage: <br />N /► r <br />15. Description of Amendment or Conversion: <br />If you are amending or converting an existing o eration, provide a brief narrative describing the proposed change(s): <br />Maps & Exhibits: <br />Submit two (2) complete, unbound copies of the following application exhibits: <br />6.3.1 <br />6.3.2 <br />6.3.3 <br />6.3.4 <br />6.3.5 <br />6.3.6 <br />6.3.7 <br />6.3.8 <br />6.3.9 <br />6.3.10 <br />6.3.12 <br />1.6.2(1)(b) <br />6.5 <br />EXHIBIT A - Legal Description and Location Map <br />EXHIBIT B - Site Description <br />EXHIBIT C - Mining Plan <br />EXHIBIT D - Reclamation Plan <br />EXHIBIT E - Maps, to include the location of any recorded easements <br />EXHIBIT F - List of Other Permits and Licenses Required <br />EXHIBIT G - Source of Legal Right -to -Enter <br />EXHIBIT H - Municipalities Within a Two-mile Radius <br />EXHIBIT I - Proof of Filing with County Clerk <br />EXHIBIT J - Proof of Mailing Notices of Permit Application <br />EXHIBIT L - Permanent Man -Made Structures <br />ADDENDUM 1 - Notice Requirements (sample enclosed) <br />Geotechnical Stability Exhibit (as required) <br />