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OR <br />Y <br />1~. Prsssat land use VACANT AGRICULTURAL <br />(i.e., agricultural, iaduatrial, etc.) <br />15. Proposed future load uas VACANT AGRICULTURAL <br />(Coal of raelamation) <br />INSTRQCTIONS: ThL application form moat be submitted 1n duplicate and each fora must <br />be aeco~+aaled by the following informa[Son and items. The application <br />will not ba processed until complete. See RULE 3 (for Limited Impact) <br />or BIJLE 4 (tor Spacial 10-day) for additional guidance. <br />E7fItIBIT A - Legal Descsiption <br />Tha legal description must Sdentify the affected Iand and be wholly adequate for <br />field location of the property. IC can be In the form of metes and bounds surrey <br />or a description by refnrenee to iovnship, range, and section to at least the <br />nearest gwrtar quarter aeetion. Where applicable, the street address or Lot <br />number(s) may be used. <br />E7ff3IDIT B - 'iining Plaa <br />This can be a general dlacussioA of the methods, equipment, phases or <br />the operation ind Chose portions of land affected by each. The plan <br />closely correlated with the map and should shoe where extraction will <br />direction is will proceed. <br />E.'IHIBIT C - Hap <br />.~ <br />stages oc <br />should be <br />begin, whit <br />This map should be as comprehensive as possible in terns of clearly defi.aing <br />the permit boundaries and indicating all roads or sto:icpile areas to be used in <br />connection with the operation. All immediately adjacent Lardovners must be shown <br />The closest quartos section corner, section line, or any other locateable point <br />should also ba show on the mao. <br />E.~IIBIT 7 - .111dI1te, Water Resouzces, Vegetation and Sei1s Infor-at'_on <br />Each of the above-mentioned subjects must Se addressed a; ouc'_ined in the <br />applicable Rule, under item number ten (10). <br />E(FiIBIT E - Reclamation Plan <br />As v1:h the mining plan, this should be a 3eneral discussion of toe aechods, <br />equi?merit, phaaea or stages of the reclamation process and those portions of <br />land affected by Hach. If possible, [he plan should ~~e c'_osely correlated <br />with tie map. If not, the narrative must be comprehensive enough to dzaw a~ <br />accurate verbal picture of the expected physics! appearance of the area nice <br />completion of reclamation. <br />E%}iIB1T r' - Proof of Local Government Aooroval <br />This gust be a letter from the local gove nmenc specifying conformance with <br />existing soning regulations. <br />E.'4iIBIT G - Source of Legal Right to °_n ter <br />This could be a copy of the lease, deed, abstract of title, oc current tax <br />receipt. In lieu thereof, a statement acknov'_edged Sy a notary public t`.:at <br />the operator has the legal right to enter and mine will be accepted. <br />•tFC`R SF°_Cl.1L 10-DAY PERHITS ONLY** <br />ERliIBIT kl - Reclamation Coats <br />If the surety 1s requested to be less than S?500, the operator Oust submit <br />!acts to support such request. Otherwise a surety of 5500 will automatically <br />be set. <br />~t <br />ESHIBIT I - Tema of Governmental Contract <br />Ths operator must submit a copy of the contract or ogler proof [hat prove <br />necessity of a special 10-day ?ermit. :'`.ie cperator must also submit evidence <br />of the surety provl_'ed under ~.:e _over~r..~:::c.~: ._-:ic'. '_' it s+as requ!red. <br />