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110 Permic Application (cont'd) • • INSTRUCTIONS: This applLcation and all accompanying materials must be su hinitted in duplicate. In the interests of efficient prn.:e sling, pleasa include the following information L itc:.t;. Lic:i tcd Ir:;.cct Cpcrct'_cnc, ccc ..°.;.'I-°_ 3 for guidance; Special 10-day Permits, see RULE 4 for gu id:ince. 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 Che form of metes b bounds survey or a descrip- tion by reference to township, range, and section, to a[ least the nearest quarter- quarter section. Where applicable, the street address or lot number(s) my be used. EXHIBIT B - MSninQ Plan This can be a general discussion of the methods, equipment, phases or stages of the operation and those portions of land affected by each. The plan should be correlated with the map and should shoe where extraction will begin, and which direction, if any, it will proceed. EXAIBIT C - Hap This map should clearly define permit boundaries and Sndlca[e all roads or stockpile areas to be used in connection with the operation. All immediately adjacent landowners must be shown. The quarter section corner, section line, or any other locatea6le points should also be shown on this map. EXHIBIT D - Wildlife, Water Resources. Vegetation and Soils Information Each of the above-mentioned subjects must be addressed as outlined in the applicable RULE. EXHIBIT 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 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 Coverttment Approval This must 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 application. To do so, the operator must submit evidence which Indicates that local government approval is currently pending or will aC least be considered within a reasonably short time by the appropriate govern- ing body RLZE 1.1(10) (Consul[ this RULE for full details on this requirement.) EXHIBIT G - Source of Leal R1eht to Enter This could 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. EXHIBIT H - Reclamation Costs For a 110 permit, if the operator requests surety to be less than $2500, the operator must submit facts to support such a request. Othervise, a surety of $2500 will automatically be set. For all 111 permits, the surety shall be $2500 per acre. EXHIBIT I - Terms of Governmental Contracts For Special 10-Day (111) Permits, the operator oust submit a copy of the contract or other proof that proves the necessity of a special 10-day permit. The operator must also submit evidence of the surety provided under the governmental contract, if it was required. NOTICE PROCEDURES After [he application is considered "filed" (pursuant to RULE 1.1(10) with [he Mined Land Reclamation Division, notice procedures outlined in RULES 3.2 and/or L.2 must be followed. (Format for such notices will be included in the letter you receive from the lII.R staff informing you of the completeness ("filing") of your application. ADDITIONAL INFOR~]ATION This space can be referenced for further information of any of [he items on Ch1s form. To [he best of my knowledge, all the information presented in this a lication is true and correct. /> BY ~ ~~ c ~~ TITLE / ~ / _ (S_gncd b•: ividu.~l trp ally anthor- iztu [e b~ Cnz cporator Co [his a;?lie ca icn.)