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l10 Permit Application (e nnt• - <br />INSTRUCTIONS: TIr1s appllta[Son and all accompanying materials must be cu hnntttc<1 Ln <br />Jupllunta. In Cho incorests of officlent prnceesSnq, plnaae Sncluda <br />tlrc following Snfo rsaclcn ~ i:cm~. Lir.,i cc~ 1-peer Cpc:c:'_cnc, ccc °.t19 <br />3 for guidance; Special 10-day Permits, see RULE 4 for guidance. <br />EXHIBIT A - Legal Description <br />The legal description must identify the affected land and be wholly adequate for field <br />location of the property. It can be in the form of metes b bounds survey or a descrip- <br />tion by reference to tovnihip, range, and section, to at least the nearest quarter- <br />quarter section. where applicable, the street address or lot number(s) my he used. <br />EX1iIBIT B - lfininR Plan <br />This can be a general discussion of the methods, equipment, phases or stages of the <br />_ operation and those portions of land affected by each. The plan should be correlated <br />with the map and should shoe where extraction will begin, and which direction, if any, <br />tt will proceed. <br />EXHIBIT C - Hap <br />This map should cleacly define permit boundaries and indicate all roads or etockpLle <br />areas to be used in connection vich the operation. All iam~edia[ely adjacent landowners <br />must be shown. The quarter section corner, section line, or any ocher loca[eable <br />points should also be shown on this map. <br />EXHIBIT D - wildlife, Water Resources, Vegetation and Soils Information <br />Each of the above-mentioned subjects must be addressed as outlined in the applicable <br />RULE. <br />EXHIBIT E - Reclamation Plan <br />As vich the mining plan, this should be a general discussion of the methods, equipment, <br />phases or stages of the reclamation process and those portions of land affected by each. <br />If possible, the plan should be closely correlated vich the map. If not, the narrative <br />muse be comprehensive enough to draw an accurate verbal picture of the expected appear- <br />ance of the area a'ter completion of reclamation. <br />E:OiIBIT F - Proof of Local Government Approval <br />.This must be a letter from [he local government specifying conformance with existing <br />zoning regulations. (I[ is intended Chat operators may obtain local government approval <br />concurrent with the Division's processing of the application. io do so, [he operator <br />must submit evidence vhl ch indicates chat local government approval is currently pending <br />or will at least be considered within a reasonably short time by the appropriate govern- <br />ing body RULE 1.1(10) (Consult this RULE for full details on this requirement.) <br />EXH IB i'f C - Source of LeRa1 Rieht to Enter <br />This could be a coot' of the lease, deed, abstract of title, or current tax receipt. <br />An acceptable alternative would be a statement acknowledged by a notary public that <br />the operator has the legal righC to enter and mine. <br />EXHIBIT H - P.edlemation Costs <br />For a i10 permit; if the operator requests surety to be less than $2500, the operator mrst <br />submit facts Eo sbpp6rt su clr a request. Otherwise, a surety of $2500 will automatically <br />be sec. For all 111 permits, [he sure[; shall be $2500 per acre. <br />EXHIBIT I _ Tarns of Governmental Contracts <br />For Special i0=buy (111) Perm.i ts, [he operator must submit a copy of [he contract or <br />other proof that proves the necessity of a special l0~ay permit. The operator must <br />also submit evidehde of tha surety provided under the governmental contract, Lf it vas <br />required. <br />NOTICE PROCEDURES <br />After tiro appiicatitin is considered "filed" (pursuant to RUi.E 1.1(10) with the "fined <br />Land Reclamation DiJ4sion, 3oticc procedures outlined in RULES 3.2 and/or 4,2 must be <br />fcllowed. (Format for sbch ttiotices will be included Sn the letter you receive from the <br />}:..R staff infoming ydv if t&? completeh'ess ("filing") of your applicatfon. <br />A1)'J E~ZON?. L. tNFOR1ATI0N <br />This r;.ace car, be reference,' `.,r Fu:. ~.... information of any of the items on [his form. <br />To tho,.6e5[ of my knowledg'. •1 t .nformation presented in [his application is true <br />and cocce~~: <br />BY ~ i <br />TL1 LE <br />(SizneJ ! Jig :Ju.,l ~.. .t~irhor- <br />izai ro ~ tr,l ;nr npl~r, nr (.. '.I_. <br />•. ~ <br /> <br />rl <br />