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~r - ,. _ _~ ~ • -z TYPE OR PRI^:T CLEAP.LY 14. Present land use Clay mine (i.e., agricultural, industrial, etc.) 15. Proposed future land use Residential (Goal of reclamation) INSTRUCTIONS: This application form must be submitted in duplicate and each form must be accompanied by the following infor^~ation and items. 'Ihe application will not be processed until complete. See RULE 3 (for Limited Impact) or RUZE 4 (fer Special 10-day) for additional guidance. EXHIBIT A - Legal Description The legal description must identify the affected land =_n3 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 to•.mship, range, and section to at least Cite nearest quarter quarter section. Where applicable, the street address or lot number(s) may be used. EXHIBIT B - inning 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 :rhere extraction will begin, which direction it will proceed. Eu4iIBIT C - This :nap should be as comprehens'_ce as possible in terms of clearly defining the permit boundaries and indicating all roads or stozlcpile areas to be used in connection with the operation. All iasediately adjacent landowners must be shown. The closest quarter section corner, section line, or any other locateable point should also be shown on the man. EXHIBIT D - Idildlife, ?later Rescurces, Vegetation and Soils Information Each of the above-mentioned subjects must be addressed as out'_ined in the applicable P.u1e, undet item number ten (1C). 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. E;dIIBIT F - Proof of Local Government Aoorova2 This must be a letter from the local government specifying conformance with existing zoning regulations. E7vIIBIT G - Source of Leal 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 legal right to enter and mine will be accepted. *tFOR SPECIAL 10-DAY PEPu~1ITS OVLY'~* E~4iIBIT II - Reclamation Costs If the surety is requested to be less than $2500, the operator must submit facts to support such reeuest. Otherwise a surety of $2500 will automatically be set. EXHIBIT I - Terns of Governmental Contract The operator must submit a copy of the contract or oth=_r proof that proves the necessity of a special 10-day permi*_. The operator must also submit evidence of the surety provided under the governmental contract, if it was required.