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'~~_ ID ~*~ t~ i.Y *''' • TYPE OR PRINT CLEAIiLTi • ~4. Present Iand use <i.e., agricultural, industrial, etc.) '~~ rz.c ..ter.. y,ae 15. Proposed future land use ~_Cc-, ti ,~c a ,~.., `r„ ,z„z Ja (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 1 (for Limited Impact) .,,~rSW:_ ~,or BULE 4 (for Special 10-day) for additional P,uidance. T' -J , ~. ``. ..i ~. .. .. . • . ~IIBIT A - Legal Description The legal description must identify•tlie affected land and be wholly adequate for field location of the property. It can be !n the form of metes and bounds survey or a description by reference to township, range, and section to at least the nearest quarter quarter section. Where applicable, the street address or lot :.number(s) may be used. EXBIBIT_B - Hining 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 closely correlated with the map and should show where extraction will begin, which -. direction it will proceed. E7CRIBIT C - Map This map should be as comprehensive as possible in terms of dearly defining ' the permit boundaries and indicating all roads or stockpile areas to be used in connection with the operation. ..^.11 immediately adjacent landowners must be shown. The closest quarter settler. corner, section line, or and ocher loczteable point should also be shown on the map. • fiXHIBIT D - Wildlife, Water Resources, Vegetation and Soils Information Each of the above-mentioned subjects must be addressed as outlined in the applicable Rule, under item number ten (10). E]4lIBIT E - Reclamation Platt ~`~'" As with the mining plan, this should be a general discussion of the methods, •:~., _ equipment, phases or stages of the reclamation pruceas and Chose portions of `r land affected by each. If possibl.:, the plan 9houtd be closely correlated with the map. If not, the narrative must be comprehensive enough to draw an _. accurate verbal picture of the expected physics:[ appearac:ce of the area after completion of reclamation. EXIfIBIT F - Proof of Local Covernment_~ oval This must be a .'.etter from the local government specifying conformance with existing coning reGulations. E%HIBIT G - Source of Legal Right to Enter This could be a copti of the lease, deed, abstract of title, or current tea ' receipt. In lieu thereof, a statement aclrnowledge•i by a notary public that the operator has rte legal right to enter and mine will he ar,cepted. **FOR SPECIAL 10-DAY PERMITS ONLY** ERHIBIT ll - Reclamation Costs If the surety is requested to be less than $2500, the n;~~rar.or must submit `, facts to support such request. Otherwise a surety of $25%'-U w'_11 automatically • be set. .,:. E%HIBIT I - Terms of Governmental Contract The operator must submit a copy of the contract or other proof shoe proves the necessity of a special 10-day permit. T'lie operator must also submit evidence of the Surety provided under the governmental contract, if it was required. ',:-: '.