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` - - • TYPE OR PRINT CLEARLY
<br />14. Present land use ~GiP/~. ~~~~//A.c7~ f ~,~/~/i.0/r
<br />(i.e., agricultural, industrial, etc.)
<br />15. Proposed future land use /, ~i//~/~~~ ~` o~i~df.S~OC/i' ~,q~i/.4~
<br />(Goal of reclamation} ~~ j~( ~~~~~ /S
<br />INSTRUCTIONS: This application form must be submitted in duplicate and each form must
<br />be accompanied by the following information and items. The application
<br />will not be processed until complete. See RULE 3 (for Limited Impact)
<br />or RULE 4 (for Special 20-day) for additional guidance.
<br />EXHIBIT A - Legal Description
<br />The Legal description must identify, the affected land and be wholly adequate for
<br />field location of the property. It can be in the form of metes and bounds survey
<br />or a description by reference to township, range, and section to at least the
<br />nearest quarter quarter section. Where applicable, the street address or lot
<br />number(s) may be used. ~~~~s~ oSE~ 6E, ~ A1~A~E~ ~~.~ER
<br />EXHIBIT B - Mining Plan
<br />This caw be a general discussion of the methods, equipment, phases or stages of
<br />the operation and those portions of land affected by each. The plan should be
<br />closely correlated with the map and should show where extraction will begin, which
<br />direction it will proceed, ~ U~~N ~~~ _ ~~~~5~ ~~~ ~~,~c/~d ~~~f~,P
<br />EXHIBIT C - :".afl
<br />This map should be as comprehensive as possible in terms of clearly defining
<br />the permit boundaries and indicating all toads or stvclcpile areas to be used in
<br />connection with the operation. All immediately adjacent landowners must be shown.
<br />The closest quarter section corner, section line, or any other locateable point
<br />should also be shown on the map. ~,9~ ,q,eC Af/A L~P~
<br />.IT D - Wildlife. Water Resources. Veeetation and Soils Information
<br />Each of the above-mentioned subjects must be addressed as outlined in the
<br />applicable Rule, under item number tea (10) . /~/~A,St` aS~ /~~/f/7r~ /Q i ~
<br />.9 //`ACh E p/ SCE ~/f,~ - .q/SCE ~9~AC`lfG~
<br />E:{HIBIT E - Reclamation Plan ~~~~ Q/~C~~
<br />As with the mining plan, this should bA a general discussion of the methods,
<br />equipment, phases or stages of the reclam:~tion process and those portions of
<br />land affected by each. If possible, the plan should be closely correlated
<br />with the map. I£ not, the narrative must be comprehensive enough to draw an
<br />accurate verbal picture of the expected physical appearance of the area after
<br />completion of reclamation. f~/~q~~' ~ ~~ i ~~ iyy~ ~ // ~/v ,q ff~~jfL7~~~/`/C.E
<br />EXHIBIT F - Proof of Local Government Approval
<br />This must be a letter from the local government specifying conformance with
<br />existing zoning regulations. ~~~. f~•<'d S~CU'ei~Uq ~~7a5 ,~~0/YY) /-`"~~/"YYiOif/~ i
<br />C'outif~.,~zs/~~2 ia~,'FlchEd.gpo/c~~i~/r1 ~ ~/,~rrn.
<br />EXHIBIT G - Source of Legal Right to Ente
<br />This could be a copy of Che lease, deed, abstract of title, or current tax
<br />receipt. In lieu thereof, a statement acknowledged by a notary public that
<br />the o erator has the legal right to enter and mine will be accepted.
<br />/~,CE,gsf s~~ af~.gchfd 4Ef1~,~ f~om~ ~.n/a-,-~~s T,e~~~
<br />**FOR SPECIAL 10-DAY PERMITS ONLY*`
<br />EXHIBIT H - Reclamation Costs
<br />If the surety is requested to be Less than 52500, the operator must submit
<br />facts to support such request. Otherwise a surety of $2500 will automatically
<br />be set.
<br />EXHIBIT I - Terms of Governmental Contract
<br />The operator must submit a copy of the contract or other proof that proves the
<br />necessity of a special 10-day permit. The operator must also submit evidence
<br />of the surety provided under the governmental contract, if it was required.
<br />,~ ~ '-_,
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