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<br />TYPE OR PRINT CLEARLY <br />-z- <br />2f. Present land uae Af:ricul[ural - Dry Rangeland <br />(1, e., agr icul[ural, lnduatrlal, etc,) <br />W'ld Hahita <br />15. Proposed future land use ~ri rul rural - Tlr3f' Ran~l and <br />(coal of reclamation) Recreational Wildlife Habitat <br />INSTRUCTIONS: Thla appllcatioa fora moat De submitted !n duplicate and each form must <br />be accomp an led by Che following Snfor~atlon and Stema. The epplicatSon <br />will not be proc eased until corp lets. See RULE 3 (for LSmited Impact} <br />or awe c (for Special 10-day) Eor addlt Tonal gu Sdance. _ <br />=)3IBIT A - Legal Pescrlp[Son <br />the legal description =oat Sdent Sfy [:~e affected land and be vhol ly adequate for <br />f it ld location of [he pro percy. IC can ba in the form of mete! and bounds survey <br />or a deacrSptlon by reference [o tovnahf p, range, and section co at 2eaet the <br />nearest quarter quarter sec[So n. There ep placable, the street add[ ens or lot <br />nunber(a) ,ay Se used. <br />~iI9IT 9 - Yinlnq Tian <br />ThSs can be a general discuas!on of [he ee chod s, equipment, phases or stages of <br />the operation and those po [[Sens of land affected by each. The plan should be <br />closely cor-ela led with the cap and should show where eztrac[ion will begin, vh ich <br />d!rectlon i[ will proceed. <br />-113IT C - .`tap <br />~S a cap should be as ce~pree ^.s _ve as p^ss lh le 1^ terra of clearly defining <br />cSe perm[ bounds r es .:nd :nd!ca t:ng all roads or stockpile area9 to be used 1n <br />cc:.-.ec [Son v:ch c`.e e~erat :on. All L=:ad Sorely adjacent landowners rust be shown. <br />-:~e [loses[ quarter oeet!cn cc r:.P r, section 1!ne, oc any other loca[eable po ln[ <br />,[cold also Se sSc ~r on t`,e rap. <br />-~~*3iT 7 - '; 1'i~'r' " ~t '=so~r-es_`. - :zrion aid So Ls Infer-a [!on <br />_;.h of the a'cn'e-- _ Cc~~d -vSiects :a Se =cdressad as outlined 1n [he <br />,;._pllr ab le 4u2e, ~.:.ider !t~~n c__i~_r 'en (:O). <br />-~::13Ii 'c - ?e c_'--st: an ?'an <br />is virh the =~_ninq ?!+~, :his s~^o~iid ~e a fir. ~e:a1 dis cuss loo of [he oe [Sods, <br />{_Spcent, p`.a .; ~~s or stn Ens of C,e rec'__ 'r Scn pc DCB69 and [hose 7ortleos of <br />l,c,d affected Sy each. If pens _Sle, L..^_ p!an sb'u ld Se closely correlated <br />with the :-ap. if .,cc, c`.r r.a .-: t'_ve -L'st Se cc-pre hang lve enough to do av an <br />,.=:ur ate ':crbal cture of t:-e e:•:ree ed ,'a~sfcal apoear once of the area after <br />co~pl etion of recl_a ton. <br />•:dI3IT F - Prcof of Local Gc_. err_r.[ A.. ~roral <br />-`Se rust Se a '. secs[ frog [he Secal gouerrment specif ying conforaance vl th <br />~.a'_s ring inning requi atlooa. <br />\'413Ii G - Sc ores of `-e:al F_L~ht ;o cater <br />Ttr1e too Ld he a rnpy of the leans, deed, aSs cac[ of calls, of current tas <br />receipt, In 1!eu thereof, a s[atece nt aci ~ov2edged by a notary publ le [hat <br />cSe cpera roc has the legal right ce enter and nine will be accepted. <br />•"e'GR Sr CIAL 10-OaY 7h'9i.5 0:7Yk• <br />?yi'_3 LT H - 3er tar atlcn Cc s[s <br />IE the surety !s recuested [o be less CSan 52500, the operator mwt submit <br />fat to [a support such request. GLS erv Lse a surely of 52500 will autorutically <br />:e set. <br />Es:riI31r I - Terms of Cove rnacn[al Contra[[ <br />:he operator moat submit a copy of rhe con erne[ or other proof that proves tha <br />nee eseity of a special 10-day permit. The operator must al ao submit ev ids oce <br />of the cure [y prow Sded under [he governr.en tai contract, if S[ uaa requlzed. <br />