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• -2- PRINT CLEARLY 14. Present land use SAND AND C~RAVFI PIT nDCaercn o.. (i.e., agricultural, industrial, etc.) PREVIOUS OWNER. 15. Proposed future land use _ AGRICULTURE OR INDUSTRI AI WARF NY111CIn,G~ (Goal of reclamation} INSTRUCTIONS: This application form must be submitted in duplicate and each form must be accompanied by the following information and items. The application will not be processed until complete. See RULE 3 (for Limited Impact) or RULE 4 (for Special 10-day) for additional 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 and bounds survey or a description by reference to township, range, and section [o at least the nearest quarter quarter section. Where applicable, the street address or lot number(s) may be used. EXHIBIT B - Mining Plan This can be a general discussion of the methods, equipment, p}lases or stages of the operation and those portir,ns of land affected by each. The plan should be closely correlated with the map and should show where extraction will begin, which direction it will proceed, EXHIBIT C - Map 'This map slinuLd he as comprehensive as possible in terms of clearly defining the permit boundaries and indicating all roads or stockpile areas to be used in connection with the operation. All immediately adjacent landowners must be shown. The closest quarter section corner, section line, or any ether lncateable point should also he shown nn the map. EXHIBIT D - [Jildiife, Water Resources, Vegetatior. and Sctls Tnformation Each of the above-mentioned subiects must be addressed as outlined in the applicable Rule, under item number ten (10). EXHIBIT E - Reclamation Pl.nn P,s with the minim; plan, this should be ~ general discussion of the methods, equipment, phases or titaces of the reclamation process .nd tho:.e ~~rtions of land affected by each. If possible, the plan should be closely correluted with the map. if not, the narrative must be comprehensive enoueh [o draw an accurate verbal pic[ura of the expc•c[ed physical appearance of the area after completion of reclamation. EXIIIBIT F - Proof of Local Government AP"nrnval This must be a letter from the local government specifying conformance with existing zoning regulations. EXHIBIT G - Source of Legal Right to Enter This could be a copy of the lease, deed, abstract of title, or current tax receipt. In lieu thereof, a statement acknowledged by a notary public that the operator has a •• legal right to enter and mine •.•ill be accepted. **FOR SPECIAL 10-DAY PERMITS OILY+* EXHIBIT it - Reclamation Costs If the surety is requested to be less than 52500, the onerator must submit facts to support such request. Otherwise. a surety of $2500 will automatically be set. EXHIBIT I - Terms of Governmental Contract The operator must submit a copy of the contract or other proof that proves the necessity of a special 10-day permie. The operator must also submit evidence of the surety provided under tt~e governmental contract, if it was required.