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-4- 15. Description of Amendment or Conversion: If you are amending or converting an existing operation, provide a brief narrative describing the proposed change(s): Maps & Exhibits: Submit two (2) complete, unbound copies of the following application exhibits: 6.3.1 EXHIBIT A -Legal Description and Location Map 6.3.2 EXHIBIT B -Site Description 6.3.3 EXHIBIT C -Mining Plan 6.3.4 EXHIBIT D -Reclamation Plan 6.3.5 EXHIBIT E -Maps, to include the location of any recorded easements 6.3.6 EXHIBIT F -List of Other Permits and Licenses Required 6.3.7 EXHIBIT G -Source of Legal Right-to-Enter 6.3.8 EXHIBIT H -Municipalities Within aTwo-mile Radius 6.3.9 EXHIBIT I -Proof of Filing with County Clerk 6,3.10 EXHIBIT J -Proof of Mailing Notices of Permit Application 6.3.12 EXHIBIT L -Permanent Man-Made Stmctwes 1.6.2(1)(6) ADDENDUM 1 -Notice Requirements (sample enclosed) 6.5 Geotechnical Stability Exhibit (as required) Responsibilities as a Permittee: Upon application approval and permit issuance, this application becomes a legally binding document. Therefore, there aze a number of important requirements which you, as a permittee, should fully understand. These requirements are listed below. Please read and initial each requirement, in the space provided, to acknowledge that you understand yow obligations. If you do not understand these obligations then please contact this Office for a full explanation. I. Yow obligation to reclaim the site is not limited to the amount of the furancial warranty. You assume legal liability for all reasonable expenses which the Board or the Office may incw to reclaim the affected lands associated with yow mining operation in the event yow permit is revoked and fmancial warranty is forfeited; ~~ 2. The Boazd may suspend or revoke this permit, or assess a civil penalty, upon a fmding that the permittee violated the teens or conditions of this permit, the Act, the Mineral Rules and Regulations, or that information contained in the application or yow permit misrepresent important material facts; T_~~ 3. If yow mining and reclamation operations affect azeas beyond the boundaries of an approved permit boundary, substantial civil penalties, to you as permittee can result; J_~ 4. Any modification to the approved mining and reclamation plan from those described in yow approved -t- application requires you to submit a permit modification and obtain approval from the Boazd or Office; J~ 5. It is yow responsibility to notify the Office of any changes in yow address or phone number;