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110 Permit Anplira[ion (c on['d~ • INSTRUCTIONS: This applicarion and all accompanying materials must be suhmitted in duplicate. In the LiteresLS of efficient processing, plea sa include ,. ~... the following info r.,,aticr, ,. .tc ~. L'_r,.i:cd '_.--^^^ C;cr-t'_a.. .,.c °."Tc 3 for guidance; Special 10-day Permits, see RULE 4 for guidance. EXHIBIT A - Legal Description The legal description must identify the affected land and be wholly adequate for field location of the property. It can be in the form of metes b bounds survey of a descrip- tion by reference to township, range, and section, to at least the nearest quar[er- quarter section. Where applicable, the street address or lot number(s) my be used. EXHIBIT H - Mining Plan This can be a general discussion of thr_ methods, ecuipment, phases or stages of the operation and those portions of land affected by each. The plan should be correlated with the map and should show where extraction will begin, and which direction, if any, it will proceed. EXHIBIT C - Map This map should clearly define permit boundaries and indicate all roads or stockpile areas to be used in connection with the operation. All immediately adjacent landowners must be shown. The quarter section corner, section line, or any other locateable points should also be shown on this map. EXHIBIT D - Wildlife, Water Resources, Vegetation and Soils Information Each of the above-mentioned subjects must be addressed as outlined in the applicable RULE. EXHIBIT E - Reclamation Plan As with the mini~an, this should be a general discussion of the methods, equipment, phases or stages o~ the reclamation process and those portions of land affected by each. If possible, the pl ~a should be closely correlated with the map. If not, the narrative must be comprehensive enough to draw an accurate verbal picture of the expected appear- ance of the area after completion of reclamation. EICHIBIT F - Proof of Local Government Approval This must be a letter from the local government specifying conformance with existing zoning regulations. (It is intended that operators may obtain local government approval concurrent with the Division's processing of the application. To do so, the operator must submit evidence which indicates that local government approval is currently pending or will at least be considered within a reasonably short time by the appropriate govern- ing body RULE 1.1(10) (Consult this RULE for full details on this requirement.) EXHIBIT G - Source of Legal Rieht to Enter This could be a copy of the lease, deed, abstract of title, or current tax receipt. An acceptable alternative would be a statement acknowledged by a notary public that the operator has the legal right to enter and mine. EXHIBIT H - Reclamation Costs For a 110 permit, if the operator requests surety to be Less than $2500, the overatorrtust submit facts to support such a request. Otherwise, a surety of $2500 will automatically be see. For all 111 permits, the surety shall be 52500 per acre. EXHIBIT I - Terms of Governmental Contracts For Special 10-Day (lIl) Permits, the operator must submit a copy of [he contract or other proof that proves the necessity of a special 10-day permit. The operator must also submit evidence of the surety provided under [he governmental contract, if it was required. NOTICE PROCE-URES After the application is considered "filed" (pursuant [o RULE 1.1(10) with the Mined Land Reclamation Division, notice procedures outlined in RllLES 3.2 and/or 4.2 must be followed. (Format for such notices will be included in the letter you receive from the .II.R staff informing you of the completeness ("filing") of your application. ADDITIONP.L INFORAaTION This space can be referenced for further information of any of the items on this form. :n the _•esr of my knowledge, all the information presented in this appi ication is true and ~.;cract. BY TII'..E ~~' (5:~~'icc in.ii :~iJ u.,! !a~, X11_: :,~ithur- i_ad C. ,y lnj Ci!e CpcC3CbC ::. Lh li a„1 1i f:C iJ:'..l