PERMFILE107157

• Permit No: M1977443
• IBM Index Class Name: Permit File
• Doc Name: LIMITED IMPACT AND SPECILA 10 DAY PERMIT APPLICATION FORM
• Media Type: D
• Archive: No

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14. Pt'2eent land use gravel pit
(i.e., agricultural, industrial, etc.) - _
15. Proposed future land use ¢razine
(Coal of..raclamat_ion) - __: ~c=~~ .._ - _
INSTRUCTIONS: Thin application form must be submitted in duplicate and each form must
ba accompanied by the following information and items. The application
will not bn processed until complete. See RULE 3 (for Limited Impact)
or RULE 4 (for Special 10-day) fog-ad'di.tional guidance.
EAiIBIT A - Legal Description
The legal description must identify the affected land and be wholly adequate for
field location of the propertq. It can be in the form of metes and bounds survey
or a description by reference to towahip, range, and section to at least the
nearest quarter quarter section. Where applicable, the street address or lot
number(s) may ba used.
E7CHIBIT B - MiniaR 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 rill proceed.
E103IBIT C - Map
Thin map should be as comprehensive as possible in terms of clearly defining
the permit boundaries and indicating all roads or stoclcpile areas to be used in
connection with the operation. All immediately adjacent landowners must be show.
The closest quarter section corner, section line, or any other locateable point
should also ba shown on the map.
E7giIBIT D - Wildlile, Water Resoureea, Vegetation and Soils Information
Each of the above-mentioned subjects moat be addressed as outlined in the
applicable Rula, under item number tan (10).
E70iIBIT E - Reclamation Plan
As with the mixing plan, this should be a general discussion of the methods,
equipment, phases or stages of the reclamation process and those portions of
land affactad by each. If possible, the plan should be closely correlated
rith the map. If not, the narrative moat be comprehensive enough to draw an
accurate verbal picture of the expected physical appearance of the area after
completion of reclamation.
EEtIIBIT F - Proof of Local Government Approval
This must ba a latter from the local government specifying conforaance with
•axiating soning raplulations.
E7{IiIBIT G - Sourea of Lestal Right to Enter
This could ba a copy of the lease, deed, abstract of title, or current tax
racaipt. Ia lieu thereof, a statemgnt acknowledged by a notary public that
the operator has the legal right to mter and mina will be accepted.
**FOR SPECIAL 10-DAY PERMITS ONLY**
E74iIBIT H - Reclamation Costs
If the surety is requested to be less than $2500, the operator must submit
facts to support such request. Otherwise a surety of $2500 will ,automatically
be set.
EESIBIT I - Terms of Governmental Contract
Ths operator smst submit a copy of the contract or other proof that proves the
necessity of a special 10-day permit. The operator must also submit evidence
of the surety provided under eha'governmental contract, if it wan required.