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• •• TYPE 0^ PRINT 14. Present.land us _.. .._(i.e.,_agriculutura]., industrial, etc.) 15. Proposed future land. use (Coal of.reclamation.) INSTRUCTIONS: This application form must be submitted in duplicate and each form must be accompanied by the following information and items. The application vill not be processed until complete. Sea RULE 3 (for Limited Lmpact) or RULE 4 (Ear Special 10-day) for additional guidance. ERHIBIT A - Lestal DescrlEtion ~- The legal description moat identify the affected land sad be wholly adequate for field locatlon of [ha property. It can be in the form of metes sad bounds survey or a description by reference to township, range, sad section to at least the nearest quarter quarter section. Where applicable, the street address or lot number(s) may be used. ERHIBIT B - Mining Plaa This can be a general discussion of the mn[hoda, aquipmeat, phases or stages of the operation and thosn portions of land affected bq each. Tha plea should be closely correlated with the ~¢ap and should shoe where extraction will begin, which direction St will proceed. ERHIBIT C - Map This map should be acs comprehensive as poeaible in terms of clearly defining the permit boundaries aaei indicating all roads or stockpile areas to be used is connection with the operation. All immediately adjacent landowners must be shown. The closest quarter section corner, section line, or any other locateable point should also be shown on the map. ERBIBIT D - Wildlife, Watc:r Resources, Vegetation and Soils Information - Each of the above-met~tionad subjects must be addressed as outlined in the applicable Rule, under item number tea (10). E]CdIBIT E - Reclamation P].aa - As with the mining plan, this should be a general discussion of the methods, equipment, phases or stages of t:ha reclamation process sad those portiens of load affected by each. If possible, the plan. should be closely correlated with the map. If not, the narrative must be comprehensive. enough to draw as accurate verbal picture of the expected appearance of the area after completion of reclamation. EXEiIBIT F - Proof of Local Government Approval - This must be a letter from the local government specifying conformance with adsting zoning regulations. ER}iIBIT G - Source of Legal Right to Enter This could be a copy of the lease, deed, abatsact o! title, or current tax receipt. Ia lieu thereof, a statement aclrnowledged by a notary public that the operator has the legal right to enter and mine will be accepted. EXiiIBIT H - Reclamation Costs If the surety is requested to be less than $2500, the operator must submit facts eo support such request. Otherwise a surety of $2500 will automatically be set. *EXHIBIT I - Terms of Govenimental Contract - The operator must submit a copy of the contract or other proof that proves the necessity of a spacial 10-day permit. The operator must also submit evidence of the surety provided under the governmental contract, if it was required. ~*FOR SPECIAL 10-DAY PERMITS ONLY