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~ TYFE OR_ 1'RItJT CLEARLY 14. Present land use WIL ~ FE IIA[iITAT (S.e., agricultural, industrial, etc.) 15. Proposed future land use WILDLIFE IIA[l1TAT (Goal of reclamation) INSTRUCTIONS: This application form must be submitted in duplicate and each fora must be accompanied by the fallowing information and items. The application will not be processed until complete. See RULE 3 (for Limited Impact) or RULE 4 (for Speclal 10-day) for additional guidance. EyF{IBIT A - Legal Description The legal description must Identify the affected land and be wholly adequate for field location of [he 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 quarter quarter section. [there applicable, the street address or lot number(s) may be used. E:dIIBIT B - Mining 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. E:~IBIT C - :tan This map should be as comprehensive as possible in terns of clearly defining the permit boundaries and indicating all roads or stockpile areas to be used in connection with the operation. All iamediately adjacent landowners must be shown. the closest quarter section corner, section line, or any other locateable point should also be shown on the map. E~iIBIT D - 'dildlife, Water Resources, Vegetation and Soils Information Each of the above-mentioned subjects must be addressed as outlined 1n the applicable Rule, under item number ten (10). E.'QiIBIT E - Reclamation Plan As with ctte mining plan, tl~1s should be a general discussion of the aethods. equipment, phases ar stages of the reclamation process and those portions of land a°fected by each. If possible, the plan should Se closely correlated with the map. If not, the narrative must be comprehensive enough [o draw an accurate verbal picture of the expected physical appearance of the area after completion of reclamation. E}~IBIT F - Proof of Local Government Approval This must be a Setter from the local government specifying conformance with existing rotting regulations. E%IiIBIT 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 the Iegal right to enter and mine will be accepted. **FOR SPECIAL 10-DAY PERI4ITS O:TLY** E~iIBIT U - Reclamation Costs If the surety is requested to be less Chan $2500, the operator must submit facts to support such request. Otherwise a surety of $2500 will automatically be set. E:~{IBIT I - Terns of Governmental Contract The operator must submit a copy of the contract or other proof that prowes [he necessity of a special 10-day permit. The operator must also submit evidence of the surety provided under the governmental contract, if it was required.