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r - <br />_¢_ <br />; a. fl._-imarv fntr.ire :Post-r~r- inlee) ;and use (check onel: <br />{:-rOO~a;;di{~R1 ~ I'3.In:'Ciaadll I,i <br />s:di iii.i rC.:'CC[ni~1C <br />SC;idc Ii 1(;: i +ecreaiior,(RC) <br />_ tie~.ei.,i, i 6t~ater;{esi;ur_si WR) <br />~:,. i'rfr.Iarv t;reseu[ :arid use tchee?t ossee: <br /> <br />RcsidcnCaiRSi _ Rccrea[ion(RC) <br />DCl'Ct0~ Cd 4Y 3tcr RCQ?L':'Ct5 j wK _.) <br />_ General Agriculture(GA) <br />_ WildlifeHabita[(WL) <br />Industrial/Commercial(IC) <br />Solid WasteDisposal(WD) <br />General Agriculture(GA} <br />WildlifeHabitat(WL) <br />_ Industrial/Commercial(IC) <br />Mining (MN) <br />11. tf this operation :vill are des ~:nated chemicals, or will result, or presently has acid mine drainage-you cannot use this application <br />for:):. Yira !rust sut~:i:it citi?cr: 11Od or 112d application form for Designated Mining Operations. In either case, you must list <br />ar„ a;;aic z;r _~~i_ ti:,?nin~ Taa~xrials, exposed or disturbed as a result of the mining operation, and whether the operation will <br />resutt ir, or press-nt~~ has acid mine drainage: <br />N~ <br />t S. Description of Amendment or Conversion: <br />[f you are amending or wnver[ing uI/ e~sting operation, provide a brief narrative describing [he proposed change(s): <br />~I:tos .4c Exhibits: <br />3izh[*.iiT, n*~o i.'':j t.nniplete, ttnhound copies ofthe following application exhibiu: <br />6...I EXHIBI7~ A - Lega! 1escription and Location Map <br />- <br />~~. ?.2 t° ' _-. ;its ii r. <br />,-:hiti3i T B - es::rr'~.ion <br />5.~.~ Hi1_~'C _ - 1in;aer"iuri <br />E <br />>~ <br />~. ` ~ l <br />T <br />~;IPIiIT I.i - tic{:l{iyliiitit)n P1itIi <br />t:. ~ .~ r.zt;iniT ;_. - ~Ia}as, to inciudc the locazion ofany recorded easements <br />6.x.6 E:~i~I3"+_ f i' - Lisl of i_ither Yrrrnits and Licenses Required <br />'.3.7 E=;IIInITt=_S_;urcefLerc;IR_ight-to-Enter <br />'.)-_.i; t:Xhlr=11 H _ hAUnici;,a~i:ie i;thin a Two-mike Radius <br />F, ~.9 EJiIIIBIT I - Pr{;of of Eliina with County Clerk <br />':. .its L;;iihi7'i-P;c;:,f;;f'v;ailing`oticesofPermitApplica[ion <br />ti3.I? I'XliiLylT =. - Pt..uar_fnt'vf:,-Made Structures <br />1,.'_;1}(n) A^T)LIdDUi?%~ i-ivoticcRequirement;(sampleenclosed) <br />6. ~ Cicotechnicul S.a,ility F:~hibit (as required) <br />