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110 Pemit Aoolication ~'d~ INSTRUCTIONS: This appl tca[Son and all aceompnnpin4 mater] als his[ b~u 6initted in duplicate. In [he interests of efficiznt prnJessin;, plr asa include Y itt ..i 1__J , ratt I, .._-..1 •..._ n 9,119 t, e olloving Sn:oraticn .. Lie..-_~ „p_.___....-, ___ 3 for guidance; Special 10-day Permits, see RULE 4 for guidance.n EXHIBIT A - Legal DescriaCion 1'he legal description must identify the affected land and be wholly adequate for field location of the property. It can be in the fora of metes b bounds survey or a descrip- tion by reference Co township, range, and section, to at least the nearest quarter- quarter section. Where applicable, the street address or lot number(s) my be used. EXHIBIT B - ?fining Plan This can be a general discussion of the methods, equipment, phases or stages of the operation and those portions of land affected by each. 'the plan should be correlated with the map and should shoe where extraction will begin, and which direction, if any, it will proceed. EXHIBIT C - `fop This map should clearly define permit boundaries and indicate all roads or stockpile areas co be used in connection with the operation. .111 immediately adjacent laadowera must be shove. the quarter section comer, section line, or any other Locateable points should also be show on this map. EXHIBIT D - Wildlife, Water Resources, Vegetation and Soils Information Each of the above-mentioned subjects gust be addressed as outlined in the applicable RULE. EXHIBIT E - Reclamation Plan As with the mining plan, this should be a geaexal discussion of the methods, equipment, phases or stages of the reclamation process and those portions of land affected by each. If possible, the plan should be closely correlated with the map. If poi, [he narrative ` must be comprehensive enough to dray an accurate verbal picture of the expected appear- ance of the area after completion of reelamacien. EXHIBIT F - Proof of Loe al Cover~ent Approval This must be a letter from the local government specifying conformance with existing zoning regulations. (IC is intended that operators may obtain local government approval concurrent with tie 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.) cSRIDIS G - Source of Legal Ri¢ht 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 R - Reclamation Costs For a 110 permit, if the operator requests surety to be Less than 52500, the ooera[or must submit facts to sunoort such a request. Otherwise, a surety of $2500 will automatically be set. For all 111 permits, the surety shall be $25C0 per acre. EXHIBIT I - Terms of Governmental Contracts For Special 10-Day (111) Permits, the operator must submit a copy of the 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 the governmental contract, if Lt vas required. NOTICE PROCEDURES After the application is considered "filed" (pursuant to RULE 1.1(10) with the Nined Land Reclamation Division, notice procedures outlined in RULES 3.2 and/or 4.2 must he fol'_oFZd.- (Fornac fur such notices wail be included in the letter you receive from the 21LR staff inf orming you of the completeness ("filing") of your application. ADDITIONAL I,`IF02~fATION This space can be referenced for further information of any of the items on this form. To the best of my knowledge, all the information presented in this application Ls true and correct. BY T~.l~ww ~ . -L~~ o ` TIIL~ 1Si ~'~rd 'o •: i!wiv:.i u,;! a ly m,thor- ltdd CO :+:^i C.~e C~~r raCOr CJ Ctt15