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I(0 Pe rmi[ Applicat ion (con ['d.) 14, Present land u e (i .e., agri- cultural, indu trial, etc.) 15. Proposed futu r land use ~ ~ L (Goal of recta ~ a[ion) INSTRUCTIONS: This application and all accompanying materials must be submitted in duplica In t e interests of efficient processing, please include the following infor Clan E items. Limited Impact Ope rations, see RULE 3 far guidance; Special 1 day emni [s, see RULE 4 for guidance. EXHIBIT A - Leoal D scri of ion The legal descripti In must identify the affected land and Se wholly adequate for (i eld location of [ e property. It can be in [he fc rm of metes E bounds survey or a description by reference co to•.+n ship, range, and section, [o at leas[ the nearest quarter-qua ter section. Where applicable, Lhe street address or lo[ number(s) may be us d. EXHIBIT B - Minin lan This can be a genet I discussion of the methods, equipment, phases or Stages of the opera d on and those portions of land affected by each. The plan should be correlated with the map and should show where extraction wi 11 begin, and which dlrec[ion, If any, twill proceed. EXHIBIT C - Map This map should cle rly define pa rmit boundaries and indicate all roads or stockpile areas to be used in connection with [he operation, AI? immedia [e ly adjacent landowners must be shown. The quarter section corner, section line, or~any ocher loca[eahle points should also be sho on [his map. EXHIBIT D - Wildli ie, Water Resources, Vepetati on and Soils Information Each of the shove- entioned subjects must 6e addressed as outlined in the aDDllcable ~ RULE. E%HIBIT E - Reciam clan Plan As wi [h [he mining plan, [his should be a general discussion of the methods, equipment, phases or stages o the reclamation process and those po rtitns of ;ar.d offs c[ed by each. If possible, the p an sneuld be closely co rrela[ed wi [h the map. If no[, the narrative must Se comprehensive enough to draw an accurate •.e rbal picture of Che expected appear- ance of the area a ter completion of reclamation. EY.H16~7 F -Proof f L^cal Government Approval This must be a let er from [he local government specifying conformance with existing zoning regulations (It is intended [hat ope ra [o rs may obtain local government approval concurrent with ch 0: vi sion's processing of the apPlica[ion. To do so, the ope ra con must submit eviden a which indicates that local govt. approval is currently pending or will at least b onside red eii [h in a reasonably short time b~~ the appropriate governing body. RULE I,I (10} (Consult this RULE for full details on [his requirement.) E%HIB IT G - Source of Le al Ri writ to Enter This could be a co y of the lease, deed, abstract of [i [le, or current tax receipt. An acceptable alt rnati ve would be a statement acknowledged by a notary public [hat tfie operator has t e legs? ri she to enter artd mine. EXHIBIT h - Rec?am clan Costs .f ;he surety )s r pue sted is be less than 52500, the ope rato^ must suhmi[ facts [o support such a req e5c. Otherwise, a surety of $2500 will automatically be set. **f FOR SPECIAL 10-DAY (I'. I) PERMITS ONLY "+ EXHIBIT 1 - Terms f love rumen [.al Contract For Special 10-Day (1 il) Permits, the ope ra [or must submit a copy of the contract or other proof that roves the net essi ty of a special 10-day pe rmic. The operator must also submit evidence of [he su racy provided upper the governmental cant tact, if is was required. NOTICE PROCEDURES After the appl ica ion ii considered "filed" (pursuant co RULE I.I (ID) with the Mined Land .°.eclamation Di vis on, notate p: etedures outlined in RULES 3.2 E/or 4.2 must be followed. (Format for such o[ices will he included in the lector you receive from the ML P, staff informing you of he comple[en ess ("filing"? of your apPlicaLi on. ADDITIONAL INFOP.MA710N This space can be referenced for further information of any of [he items on [his form. To the 6esc of knowledge, all [he information Pres en ced in this application is [rue and co rrec[. •~ P /u~ - -ITC= ISigned by individual legally author- ized Co bind the operator co this application.) te. ma- 0-