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110 Pe rmi[ ApplicaU on (con t'd.) 11, Present land use (1 .a., agrl- ~~ y~~,~.~?r/~ ~ i/,:~~:~_ cultural, industrial, etc.) ~~-- IS. Proposed future land use (Goal of reclamation) INSTRUCTIONS: This appllcatlon .and ell accompanying materials must be subml Cted In duplic:ata. In the Interests of efficient processing;~plaase Include the following Informa- tion b Items. ~Llmltad Impact Operations, sea RULE 3 for guidance; Special 10- day Pe rmits,~sae RULE 4 for guidance. [XHIBIT A - Legal Desc rip[Ion-~--~- --- ~~-- The legal description must Ident(fy the affected land and be wholly adequate for field IoeaElon of the property. IC can be in :h. `.rm of :-acs: S hc•_rtds survey or a description 6y reference to township, range, and section, to ac least the nearest quarter quarter section. Vhere applicable, the street address or lot number(s) may 6o used. .a EXHIBIT B - Hlnina Plan TAis tan be a general discussion of [he mCihods, equipment, phases or stages of the opa ration and those po rtlons of land effected by each. The plan should be corral aced with the map and should show where extraction wf 11 begin, and which dl rectlon,~lf any, tt will proceed: EXHIBIT C - Map ~ _ This map should clearly define permit hounds rtes and Indies to all Yoads or stockpile areas to be used in connection with the ape ration. A1I immediately adjacent landowners must 6e shown. The yua rter section earner, section Itne, or•any other locateable points should also be shown on Ch is map. EXHIBIT 0 - Vildlife, Water Resources, Vege cation and Soils Information Each of the above-mentioned subjects must be addressed as outlined in [he applicable RULE. EXHIBIT E - Reclamation Plan As wi to the mining plan, ch is should be a gmreru~ ~ ~,..aisi v....~ - a-tkods, aqulpr...a;, phssas or stages of the reclamation process and those pa rtlons of~land affected by each. If possible, the plan should 6e closely correlated with the map. If not, the na rra[ive awst~be cumpruren>ive enough to draw an aecurat^ va rhal picture of the expected appear- ance of the area after completion of reclamation. EXHIBIT F - Proof of Local Government Approval This must be a letter from the local government specifying conformance with existing 2cni-q -=,.!.:!.ns. (It Is '^•en"°d •''st aDe rarpr< m .,h rain local government apP rovai eoncu went with [he Division's processing of the apPl~i cation. To do so, the operator em:; - `~!t -.. - _ ~: :~!c". Indic-tee that !^cal govt. ~Pp rovai is currently pending or will-at lee st 6e considered within a reasonably short time by the appropriate gn... {nlnn body. .RULE 1.1(10) (Consult this RULE for full details on [his requirement.) Er41aIT n - Source of Legal Rl~aht [o Enter This could be a copy of the lease, deed, abscract of tl lie, or current [ax receipe. An acceptable al to rnatlve would be a statemene acknowledged 6y a notary public that the opa razor has the legal rl ght to enter and mine. EXHIBIT H - Reclamation Cos [s .___ If the surety is requested to ba less than $2500, the operator must submit facts to ,f~A support °VCh a request. Otherwise, a surety of 52500 w1II automatically 6e set. ~v ++~+ FOR SPECIAL 10-DAY (III) PERMITS ONLY •*+ EXHIBIT I - Terms of Cove rnmental Contract For Special 10-Day (III) Permits, the operator must suhmlt a coDY of Cha contract ar other-proof that prgvas [he necessity of s special 10-day permit. The operator must also submit evidence of the surety provided under the gave roman cal contract, if I[ was req ui red. ~ - NOTICE PROCEDURES After the application is considered "filed" (pursuant to RULE I.I (10) with the Mined Land Reclamation Dlvisi on, notice procedures outlined in RULES ;.2 6/or 4.2 must be fol towed. (Format for such notices will be included in the letter you receive from Cha MLR Staff informing you of Cha completeness ("filing") of your application. AODIT IOIIAL INFO RMATI ON~. This space can bs referenced for further information of any of the Items on this form. To cite best of my knowledge, all the information presented In this applicatl on Is r,rue and .:o rrec t. ~'!~ ~~Li~G~~t-c/ty~~-~?m~ri BY ~~ ~~o ~ ~ -~ J9/ ~ D !1, TITLE ~,~,Sc ~6~ ~/Ld~ j //` Si d by i vidua age author- ized [o b~ d [he era [O [o this appllcatlon.)