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-4- <br /> 12. Prim ry future Post-minin land use chec <br /> Cropland(CR) Pastureland(PL) General Agriculture(GA) <br /> Rangeland(RL) Forestry(FR) Wildlife Habitat(WL) <br /> Residential(RS) _ Recreation(RC) Industrial/Commercial(IC) <br /> Developed Water Resources(WR) Solid Waste Disposal(WD) <br /> 13. Prim resent land use check one <br /> Cropland(CR) Pastureland(PL) General Agriculture(GA) <br /> ❑✓ Rangeland(RL) ®Forestry(FR) Wildlife Habitat(WL) <br /> Residential(RS) ®Recreation(RC) Industrial/Commercial(IC) <br /> Developed Water Resources(WR) EMining(MN) <br /> 14. If this operation will use designated chemicals,or will result,or presently has acid mine drainage-you cannot usethis 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 /> None <br /> 15. Description of Amendment or Conversion: <br /> If you are amending or converting an existing operation,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 EXHIBIT A - Legal Description and Location Map <br /> 6.3.2 EXHIBIT B - Site Description <br /> 6.3.3 EXHIBIT C - Mining Plan <br /> 6.3.4 EXHIBIT D -Reclamation Plan <br /> 6.3.5 EXHIBIT E- Maps,to include the location of any recorded easements <br /> 6.3.6 EXHIBIT F- List of Other Permits and Licenses Required <br /> 6.3.7 EXHIBIT G- Source of Legal Right-to-Enter <br /> 6.3.8 EXHIBIT H -Municipalities Within a Two-mile Radius <br /> 6.3.9 EXHIBIT I - Proof of Filing with County Clerk <br /> 6.3.10 EXHIBIT J - Proof of Mailing Notices of Permit Application <br /> 6.3.12 EXHIBIT L- Permanent Man-Made Structures <br /> 1.6.2(1)(b) ADDENDUM 1 -Notice Requirements(sample enclosed) <br /> 6.5 Geotechnical Stability Exhibit(as required) <br />