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I10 Pe rmft Application (con t'd.) 14. Present land use (i .e., agri- cul[u ral, industrial, etc.) 15. proposed future land use (Goal of reclamation) .v1.0IDe years usea Ior s P~p~ll ar ~P,~TI rlg ~P„~ Leave suitable for er az ( INSTRUCTIONS: This application and all accompanying ~nateria is must be suhmi clod in duplica tp. In [he interests of efficient processing, please include the following informa- tion G items. Limited Impa<[ Operations, see RULE 3 for guidance; Special 10- day Pe rmi[s, see RULE 4 for guidance. E%HIBIT A - Legal Deicri ption The legal description must identify the affected land and be wholly adequate for field location of [he property. I[ can be in the form of metes Z Sounds sv r•+ey or a des cri otion by reference to township, range, and section, to at least the nearest qua rter-q ua rter section. Where applicable, the street address or lot number(s) may be used. EXHIBIT 8 - Nininq Plan This tan 6e a general discussion of the methods, equipment, phases or stages of the operation and Chose portions of land affected by each. The plan should be co rreiateo with the map and should sh cw where ext cocci on mill begin, and which direction, if any, it will proceed. E%HIBIT C - Map This map should clearly define permit boundaries and indicate all roads or stockpile areas [o be used in connection with the operation. All immediately adjacent landowners must 6e shvan. The quarter section corner, section line, or~any other Iota [eable points should also be shown on this map, EXHIBIT D - Wildlife, Ua *.er Resources. Vegetation and Soils Information Each of [he above-mentioned subjects must be addressed as outlined in [he applicable RULE. E%HIBIT E - Reclamation Plan As with the mining plan, [his should be a general discussion of [he methods, equipment, phases or stages of the reclamation process and those pe rtions of land affected by each. If possible, [he plan should be closely co rrela[ed with [he map. If no[. [he na rracive must be comprehensive enough [o draw an accurate verbal picture of the expected appear- ance of the area after completion of reclamation. EXHIBIT F -Proof of Local Government Approval This must be a letter from [he local government specifying conformance with existing zoning regulations. (I[ is intended that operators nay obtain local gcvernment app royal concurrent with the Division's processing of the application. To do s0, the operator must suhmit :.vi deoce_whi ch indica:ps chat local govr, approval i; currently pending or mill at least be considered within a reasonably sno r[ time by the apprcpri a:. governing body. .RULE I.1 (ID) (fonsuit this RULE for full details o.T this req ui cement.) EXHIBIT G - Source of Legal Ri oht [o Enter This could 6e a copy of the lease, deed, abstract of Ci tle, or cur ran[ tax receipt. An acceptable alternative would be a statement acknowledged 6y a notary public that the operator has the legal right [o enter and mine. EXHIBIT H - 0.eclama[i on Los [s If [he surety is requested [o be less than 52500, [he operator must submit facts to support such a request. Oche rwi se, a surety of $2500 will automatically be set. *** FOR SPECIAL 10-DAY (II1) PERHITS CNLY "+ EXHIBIT I - Terms of Governmental Contract For Special 10-Day (111) Permi [s, [he operator muse submit a covY of [he contract or other proof [hat proves the necessity of a special 10-day permit. The operator must also submit evidence of the surety provided under [he governmental contract, if it was req ui red. NOTICE PAOCE DURES A Fter [he application is considered "filed" (pursuant to RULE 1.1(!0) with [he Mined Land Reclamation Division, notice proced uras outlined in RULES 3.2 E/or 4.2 must be followed. (Format for such notices will be included in the letter you receive from the MLR Staff informing you pf Che completeness ("Filing") of your applica[i on. u ADDIi1011 AL INFOAHATI UN -~ ~~ ~ - - '- This space can be referenced for further information of any of the items cn this form. To [he best of my knowledge, all [he in fo rmati en present `d in this application i true and correct. /• l + G~ /9Y ~ ~/ TI?LE C F_OL©~ / ~(Sioned by ~ndivicpal legally au[nor- ized to bind the operator to Chis application.)