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E OR PRINT CLEARLY _ 14. Present land use ~ ~•Jil~life :3abitat (i.e., agricultural, industrial, etc.) 15. Proposed future land use 'dildlifa H:~hifat (Goal of reclamation) INSTRUCTIONS: This application form must be submitted in duplicate and each form must be accompanied by the following inforvation 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. F:~1iIBIT A - I.e~a1 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 to at least the nearest puarter quarter section. I~Tnere applicable, the street address or lot number(s) may be used. E?Q?IBIT B - Niininq Plan This can be a general discussion of the methods, equipment, phasas 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. E'OiTBIT C - bfap This map should be as comprehensive as possible in terns of clearly defining the permit boundaries and indicating all roads or stn=lcpile areas to be used in connection with the operation. All im•nediately adjacent landowners must be shown. The closest quarter section corner, section Line, or any other locateable point should also be shown on the Pap. EXHIBIT D - Wildlife, Water Resources, Veeetation and Soils Inforaation Each of the above-mentioned subjects must be addressed as outlined in the applicable Rule, under item number tea (10). EXHIBIT E - Reclamation Plan As with the mining plan, this should be a general 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 not, the narrative must be comprehensive enough to draw an accurate verbal picture of the expected physical appearance of the area after completion of reclamation. r.~iIBIT F - Proof of Local Government Approval This must be a letter from the local government specifying conformance with existing zoning regulations. EXHIBIT G - Source of Leeal Right to Enter This could be a copy of the lease, deed, abstract of title, or current taz receipt. In lieu [hereof, a statement acknowledged by a notary public that the operator has the legal right to enter and mine trill be accepted. **FOR SPECIAL 20-DAY P°RHITS O\TLY** EXHIBIT H - Reclamation Costs If the surety i.s requested to be less than $2500, the operator must submit facts to support such request. Otherwise a surety of $2500 will automatically be set. EXHIBIT I - Terms of Covernmeatal Contract The operator must submit a copy of the contract or other proof that proves the necessity of a special 10-day persit. The operator must also submit evidence of the surety provided under the governmental contract. if iL was required.