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110 Pemit :\polication (con t' INSTRUCTIONS: 'Reis application and all accompany inq materials must be suh¢itted in duplicate. Ln the lnte rests of etficlant protessir.5, ,.l c.a se in~lade the foilovia info r...a -_ar. ,. _tc-.. Limitd '- -c_ ^p^ratic.r ___ Pmo 3 for guidance; Special 10-day Permits, see RULE + for guidance.-^ EXHIBIT A - Legal Description The legal description must identify the affected land and be wholly adequate for field location of the property. It can be in the form of metes 6 bounds survey or a descrip- tion by reie:rence to township, range, and section, to at least the nearest quarter- quarter seet:ion. Where applicable, the street address or lot number(s) my be used. ECHIB CT B - ?!ininR Plan This ~:aa be a general discussion of the methods, equipment, phases of stages of the opera:ion anal those portions of land affected by each. The plan should be correlated with the maps and should show where extraction will begin, and which direction, if any, it vi:Ll proceed. EXHIB:CT C - Map This nap should clearly define permit boundaries and indicate all roads or stockpile areas to be used in connection with the operation. .111 immediately adjacent landowners must Ise shown. The quarter section corner, section line, or any other locateable points should also be shown on this map. EXHIBIT D - Wildlife, Water Resources, Vegetation and Soils Information Each of the above~entioned subjects must be addressed as outlined in the applicable RULE. ERFCIBIT E - Reclamation Plan As with the mining plan, this should be a general discussion of the methods, equipment, phases or stages of the reclamation process and those portions of land affected by each. If possible, the plan should be closely correlated with the map. If not, the narrative must he comprehensive enough to dray an accurate verbal picture of the expected appear- ance of the area after completion of reclamation. E'.1HIBIT F - Proof of Local Government Approval This tmst be a letter from the local government specifying conformance with existing zoning regulations. (It is intended that operators may obtain local government approval concurrent with the Division's processing of the apnlic ation. To do so, the operator must su'omit evidence which indicates that local government approval is currently pending or vi:.l at Least be considered within a reasonably short time by the appropriate govern- ing body PULE 1.1(10) (Consult this RULE for full details on this requirement.) E'OiIBIT G - Source of Legal Rieh[ to Entei This ::ould be a copy of the'lease, deed, abstract of title, or current tax receipt. An acceptable alternative would be a statement acknowledged by a notary public that the operator has the legal right to enter and mine. EXAIB IT R - Reclamation Costs For a 110 permit, if the operator requests sure C+ to 6e less than $2500, the operator mist submit facts to support such a reeuesc. Otherwise, a surety of 52500 will automatically be set. For all 111 permits, the surety shall be 52500 per acre. EXHIBIT I - Terms of Governmental Contracts For Special 10-Day (111) Permits, Che operator must submit a copy of the contract or other proof that proves the necessity of a special l0~ay permit. The operator must also submit evidence of the surety provided under the governmental contract, Lf it vas requi.ed. NOTICE PROCEDURES ~~f<er t~i-e appl~ation 3s considered zire3" (pursuan o IILE'T.T(1CT wicri'Ziz Mined- Land Declamation Division, notice procedures outlined in RULES 3.2 and/or 4.2 must be followed. (Format for such notices will be included in the letter you receive from the ?II.R staff informing you of the completeness ("filing") of your application. ADDITIONAL LNFOR.~L4TION This space can be referenced for further information of any of the items on this form. To the best of my knowledge, all the informatio presented in this application is true and cerreet. ~ (~1LaCa b•: i~taia.,; u.;l !: ]~11 .~ rrthr-- iscd ea bir,' t..a c,eraror w this __ ,~ E~..C! ... .1 -, ~;,