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I10 ?er~lt Aool its:inn fcon:'d~ L':SS3CCSi0[;S: Shit apolicacion and all accomn.~rvinq ^a[c vials cost 'oc su hini cted in > duplicate. In the in ce rests o: atEiciaot rrnCLaaia;. Coav .: ~...d2 t:te fJlluVi:l3 in;at:.__ _r ..'_ ..___.. __ .~:.-__.- ___ .°._^_ 3 foc widance; Special-l0-days?e:Rits, see SULE^+ for gu i.danee.^^ E~iI3It A - Segal~Oescr!nt!on She Legal description oast identL'y the aEfectad Land and ba rhally adequ.aca fox field Location of the property. Lt cm ba 1n the fora of maces 6 bounds survey or a descrip- tion by rei ereaea to towahip, sage, sad section, co ac least the nearest quarter- gaarter saetion. Where applicable, the street address or Ioc nuaber(s) ay ba used. ~~ ~?3Ti 9 - vaiaC 21an Shia eaa ba a general dlsewsian of toe methods, equipment, ?bases or stages of the opencion and those portions of land affected by each. She plan should Se correlated with the map sad should shoe theta ssrrattion rill begin, and which direccian, if my, SL vi..l.l proceed. E~IDIS C - yao .^sin map ahauld clearly dafiaa parsdc boundaries and Sadieata all roads or stoeYpila areas to ba used Sa eooaeetion with rho ooaration. All immediately adjacaat landowara .-•.c ba shown. The gaarter saetion corner, aaeclon liaa, or any arbor lotacea6le poiau should also ba show on this map. ~TSL: D - Wi1311fe. 'later Eeaourees, yegetaeian and Soils Zaformatioa Each of the abava~nencianad sahjeeu mwt ba addrasaed as oucliaad is the appliubl• 3IILE. ~IHIS ° - Heelamatlon Plm As •rlth eha niaiag plan, this should ba a general disewaion of cha seehods, equipment, paaaea ar stages of the reelamaeinn proeasa sad chose portions of load afY.acted by each. iF possible, the ?lea-should ba closely correlated rith eha map. If not; the narrative gust be ~eompreheasiva enough to dray m accurate verbal picture of the ezpaetad appear- ance of the area after eomplaeion of raelamation. ?iI9I- y - ?roof of Loeai Coveroment :laarooal :hie must Se a Latter from cha Local government apeeifyiag confotmaaea vic:h e>da C_ag taniag regulations. (It :s Laeeadad chat operators say obtain Iaeal govet~eat approval eoncirrent •rl:h the Dlvision'a processing of the applieatioa. To do ro, c.he operator mur submit evidenen which iadicaces chat local govaramaat approval is currently pending or +111 ac least ba considered vithia a ceasooably short eim Sy the apprepriaee govern- ing body 3LZE 1.1(10) (Conaulc this 3DLE '_or full details an this requirement.) [HT~'1: - Sauree of Legal Rizht to Eaeer 'Sis could be a copy of che'leaaa, deed, abstract of title, or current tas receipt. M acceptable alternative could ba a auteneac aclcaovledged by a notary public chat the operator has t:u legal ri;ht to carat and mice. di1317 H - 2eelamatian Cash <'or a 110 permit, If cha operator :equeats surnty to be less than $2500, the ooaraeorrust~ submit facts to rupoort ouch a :eauest. Ochersise, a surety of 52500 rill aucomaeieally be sac. For all Lli parsica, the surety shall be 52500 per acre. 1T S - Seraa of Cvoernmencal Contraeta For Special 10-0ay (111) Petmita, LFie operator must rubmit a copy of the contract ar ocher proof that erovaa ehs oeeeasiry of a special lOday permit. She opararor moat also rubmic evidanen of cha surety provided under cha gocarameacal contract, if Lt +aa required. After rte applieaeion Sa eonaiderad "Filed" (pursuant to HIILE 1.1(10) rich the Pined Lind Hnelamaeian Division, notice proendurea outlined is HOLES 3.2 sad/or a.2 rust be folloead. (Format for such noe'_tea will ba Lneluded is the latter you receive from the :ff3 staff iaformiag 7ou of eha eampleceneaa ("filing") of your applieneion. ADDIRONAL LVFOZ"1SION this space eaa Sa referenced for further iaforaatloa of any of ehe items on this fora. So Che best ~~aa'tnpy ~ge, all the information preaente in this arpl' ac.lon is true and earrer`q) HE~1 $ >i~ 1 S ,.....T ERf ' 9~F ', aY ~./iLt~ ~ ~j~hER ~ / _ p V!- E' ~' c _ (Sieved i•. !a Cvi..acl ::~„ :: a~>.Clo r- . OF[SS\~C .! i]2S_::-~:.1~ ::Y CPS:aCOr`::J C:ai "'I. 1 °pars*r~/~q.~A~~~~..i,-~onmental Consultants, Ltd., R. Stephen Schermerhorn, P.E. F ()F..CO~~ ~ ` ~`"~Inu~~~~•.