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110 Permit Application (con t'd.) 14. Present land use (i .e., agrl- ~ cultural, industrial, etc.) Undeve _ I5. Proposed future land use Fish and wildli (Goal of reclamation) INSTRUCTIONS: This application and all accompany ing materials must be submitted in duplicate. In the interests of efficient processing; please include [he following informa- tlon 6 items. Limited Impact Operations, see RULE 3 for guidance; Special 10- day Permits, see RULE 4 for guidance. E%HIBIT A - Legal Description The legal description must Identify the affected land and be wholly adequate 'for field Ioeael on of the property. It can be In the form of metes b bounds survey or a descrl ptlon by reference to township, range, and section, [o at least the nearest quarter-quarter section, Vhe re applicable, the street address or lot number(s) may be used. EXHIBIT B - Mining Plan This can he a general discussion of the methods, equipment, phases or stages of the ope retion and [hose portions of land affected by each. The plan should be correlated with [he map and should show where extraction wl ll begin, and which dl rection, if any, i[ will Droceed. EXHIBIT C - Map This map should clearly define permit boundaries and Indicate all roads or stockpile areas to be used in connection with the operation. A11 immediately adjacent fandowne rs must be shown. The quarter section corner, section line, or~any other Iota [cable points should also be shown on this map. EXHIBIT D - 4i ldlife, Water Resources, Vegetation and Soils Information Each of the above-mentioned subjects must be addressed as outlined In the applicable RULE. EXHIBIT E - Reclamation Plan As wi [h Che mining plan, this should be a general dlscussi on of the methods, equipment, phases or stages of the reclamation process and these portions of land affected by each. If possihle, [he plan should be closely [o rrelated with the map. •If not, the narrative must be comprehensive enough to draw an accurate verbal picture of the expected appear- ance of the area after completion of reclamation. E%HIBIT F - Proof of local Government Apo royal - .. This must be a letter from the local government specifying conformance with existing zoning regulations. (I[ is intended that operators may obtain local government approval concurrent with [he Oi vi don's Drocessing of the application. To do so, the operator must submit evidence which indicates that local govt. aDP royal ;s currently pending or w111 at least be considered within a reasonably short Clme .by the aDp rop rt ate governing body. .RULE I.I (IO) (Consult [h iz RULE for full details on this requirement.) E%HIBIT G - Source of Lepal Ri gh[ to Enter This could be a copy of the lease, deed, abstract of [I [le, or current tax receipt. An acceptable alternative would he a statemen.L, acknow lodged ,by.~ notary public that the operator has [he legal right Co enter and mine. EXH IB I7 H - Reclamation Costs If [he surety is requested to be Tess Chan 52500, the operator must submit facts to support such a request. 0.the rWi se, a surety of $2500 will automatically be set. +** FOR SPECIAL 10-DAY (111) PERMITS ONLY +** EXHIBIT I - ie rms of Governmental Contract For Special 10-Day (III) Permits, the operator must submit a co Dy of the contract or other proof that proves [he necessity of a special 10-day pe r:nit. The operator must also submit evidence of the surety provided under [he governmental contract, if i[ was required. NOTICE PROCEDURES After the application is considered "filed" (pursuant [o RULE I.1 (10) with the Mined Land P.eclama[ion Division, notice procedures outlined in RULES 3.2 b/or 4.2 must 6e followed. (F O rmac for such notices will be included in :tie letter )ou receive iron [he Y.LR c;]ff informing you of the completeness ("filing") of your application. ADDITI Ot1AL INFORMATION This space can be referenced for fu r[her info rmatfon of any of [he items on this form. To the best of ary knowledge, all the In fo rma[IOn presented in [his apPlica tlon is true and correct. Fp~~ TITLE [.F1~4--vL..Q/) Signed by indi idual legally author- ized to bind [he o0e ra [or [c this application.) J 's~