PERMFILE42249

• Permit No: M2001033
• IBM Index Class Name: Permit File
• Doc Date: 3/28/2001
• Doc Name: CONSTRUCTION MATERIALS REGULAR 112 OPERATION RECLAMATION PERMIT APPLICATION FORM
• Media Type: D
• Archive: No

I5. Deacriotion of Amendment or Conversion:
Lf you are amending or converting an existing operation, provide a brief narrative describing the proposed change(s).
This will be a new
Maria and Exhibits:
Five (5) complete, unbound application packages must be submitted One complete application package consists of a signed application form
and the set of maps and exhibits referenced below as Exhibits A-S, Addendum 1, and the Geotechnical Stability Exhtbit. Each exhibit within
the application must be preserved as a separate section. Begin each exhibit on a new page. Pages should be numbered consecutively for ease
of reference. If sepazate documents are used as appwdices, please reference these by name in the exhibit.
With each of the 5ve (5) signed application fomts, you must submit a corresponding set of the maps and exhibits as described in the following
references to Rule 6.4, 6.5, and 1.6.2(1)(6):
EXI-IIDIT A Legal Description
EXI-IIBIT S Index Map
EXI-IlBIT C Pre-Mining and Mining Plan Map(s) of Affected Lands to include the location of any recorded easements
EXI-IIBIT D Mining Plm
EXI-IIBTT E Reclamation Plan
EXI-IIBIT F Reclamation PIffi Map
EXHIBIT G Water information
EXl-IIBIT H Wildlife information
EXI-IIBTT I Soils Infortnatian
EXHIBIT J Vegetation Ltformation
EXI-IIDIT K Climate Information
EXHIBIT L Rechunatian Costs
EXHIBIT M Other Permits and Licenses
EXHIBIT N Somce of Legal Right-To-Enter, to include holders of any recorded easements
EXHIl3iT O Owners of Record of Affected Land (Surface Area) and Owners of Substance to be Mined, to include
holders of any recorded easements
EXFIIBIT P Municipalities Within Two Miles
EXHIBIT.Q Proof of Mailing of Notices to Counry Commissioners and Soil Conservation District
EXHffiIT R Proof of Filing with Comry Clerk or Recorder
EXHIBITS Permanent Man-Made Stmc[ures
Rule 1.6.2(1)(6) ADDENDUM 1 -Notice Requirements (sample rnclosed)
Rule 6.5 Geotechnical Stability Exhibit (any required sections)
The instructions for preparing Exhibits A-S, Addendum 1, and Geotechnical Stability Exhibit are specified under Rule 6.4 and 6.5 and Rule
1.6.2(1)(6) of the Rules and Regulations. If you have any questions on preparing the Exhibits or content of the information requned or would
like [o schedule apre-application meeting you may contact the Office at 303-866-3567.