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• -2- <br />' ~ ~ TYPE OR PRINT CLEARLY <br />lv. Present land nee Agricultural, Wildlife {~ <br />(l.e., agricultural, industrial, etc.) <br />15. Proposed future lead use A.Erlcultural, Wildlife, Forestay <br />(Goal of reclamation) <br />INSTRUCTIONS: Thin application form moat be submitted in duplicate and each form moat <br />. ~ be accompaoled by the following infor~[ion and items. The application <br />will no[ be processed until complete. See RULE 3 (for Lfmlt ed Impact) <br />or HULE 4 (for Special 10-day) for additional guidance. <br />EJCH IBIT A - Legal Description <br />The legal dee cr iption sus[ identify [he affected land and be vhol ly adequate for <br />f laid location of the property. It can be in the form of metes and bounds survey <br />or a dee crlption by reference Co township, range, and aectlon to et lees[ the <br />nearest quarter quarter section. L'here applicable, [he street address or lot <br />number(s) mny be ue ed. <br />EXHIBii B - Hinioq P1 en -~ - ~ ~~. -~~-. _--_-~ ~ `~ <br />ThSe can be a general discussion of the methods, equ Spment, phases or stages of <br />the operation and [hose portions of land affected 6y each. The plan should be <br />closely correlated with the map and should ehov where ez [r act ion will begin, vh ich <br />direc cion it will proceed. <br />EXRIBIi C - Map <br />This map should be as comprehensive as pose ib le 1n terms of clearly defining <br />[he pe rmi[ boundaries and indicating all ro eda or stockpile areas [o be used Sn <br />connection with the operation. All Sxmediete ly ad~ac en[ landowners must be show. <br />The closes[ quarter section corner, section line, or any other locateable point <br />should also be shcw on the map. <br />EXHIBIT D - Vildl Sfe t/a ter Resources, Vegetation and Soils Information <br />Each of the above-mentioned eubl acts must be addressed as outlined in the <br />applicable Rule, under Item number ten (10). <br />EXHIBIT E - Reclamation Plan <br />~Ae with the mining plan, [his should be a general dlscussloo of the me [hods, <br />equipment, phases or stages of the reclamation process and [hose portions of <br />land affected by each. If possible, the plan should be closely correlated <br />with the map. If not, the narrative must be comprehensive enough [o dray an <br />accurate verbal picture of the expected physical appearance of the area after <br />completion of reclamation. <br />FX1fIBIT F - Proof of Local Government Approval <br />This must be a letter Erom [he local government spec ifying conformance with <br />existing zoning requl at ions. <br />EXHIBIT C - Source of Legal RS qht to Enter <br />This could be a copy of [he lease, deed, abstract of title, or~current taz <br />receipt. In lieu thereof, a statement acknowledged by a notary public that <br />the ope ra co[ has [he legal tight to enter and mine will be atcep [ed. <br />•*FOR 52EC LAL 10-DAY PEnMI'IS ONLY** <br />EXHIBIT H - Recl ama[ion Costs <br />If the surety fs requested to be less Chan $2500, the operator moat submit <br />facts [o support such request. Oche rvise a surety of $2500 will automatically <br />be set. <br />EXHIBIT I - Terms of Gove tnmen[al Conttac[ ~- <br />The operator must submit a copy of [he contract or other proof chat proves the <br />necesal[y of a special 10-day permit. 1'he operator must also submit ev id ante <br />of the aure[y provided under Che governmental contract, if 1[ vas required. <br />