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I10 Pe rmi[ Application (con ['d.) 14, Present land use (i.e., agri- ed E1gY1CllltllYal-IridllStTl bllt riot cultural, industrial, etc.) farmed used as 15. Proposed future land use Lake (Goal of reclamation) INSTRUCTIONS: This appli cation and all accompanying maceri als must be submi cted in duplicate. In [he int eres[s of eff icier;[ processing, please include the following informa- tion E items. Limited Impact Operations, see RULE 3 for guidance; Special 10- day Pe rmi[s, see RULE 4 for guidance. E%HIBI7 A - Legal Description The legal description must identify the affected land and be wholly adequate for field location of [he property. I[ can be in the form of metes E bounds survey or a description by reference [o township, range, and section, [o at least [he ~ nearest quarter-quarter section. Where xpPlica6le, the street address or lot ~~ number(s) may be used. EXHIBIT B - Hining Plan This can be a general discussion of the me [h ods, equipment, phases or wages of [he operation and those portions of land of Fected 6y each. The plan should be correlated with the map and should show where extraction will begin, and which dl rection, if any, it will proceed. EXHIBIT C - Map This map should clearly define permit hounds ries and indicate all roads or stockpile areas co he used in connection with the operation. All immediately adjacent landcwne rs must be shown. The quarter section corner, section line, or~any other Iota teable Points should also be shown on [his map. EXHIBIT D - Vii ldlife, lJa ter Resources, Vegetation and Soils Information Each of the shove-mentioned subjects must 6e addressed as outlined in the applicable RULE. EXHIBIT E - Reclamation Plan As with [he mining plan, this should be a general discussion of [he methods, equipment, phases or stages of [he reclamation process and those portions of land affected by each. If possible, [he plan should be closely co r.relatedwith [he map. If not, [he narrative must be comprehensive enough to draw an accurate verbal picture of the expected appear- ance of [he area after completion of reclamation. E%HIBIT F -Proof of Local Government Approval This must be a letter from the local government specifying conformance with existing zoning regulations. (IC is intended [hat ope ra co rs may ob[a in local government approval concurrent wish [he Division's processing of [he application. To do so, the operator must submi[ evidence which indicates :ha[ local govt. approval is currently pending or will at least be considered within a reasonably short time by [he app ropria[a governing body. .RULE I.1 (10) (Consult this RULE for full details on this requirement.) EXHIBIT G - Source of Leaal Right to Enter This could be a copy of [he lease, deed, abstract of [i [le, or current tax receipt. An acceptable aloe rna[i ve would be a statement acknowledged by a notary public that the operator has the legal right [o enter and mine. EXHIBIT H - Reclamation Los is If the surety is requested to be Tess than $2j00, [he operator must submit facts Co support such a request. Otherwise, a surety of $250C will au [oma[ically he se [. *** FOR SPECIAL 10-DAY (111) PERMITS ONLY '*` EXH181T I - Terms of Governmental Contract For Special 10-Day (111) Permits, the operator must submit a copy of the cone ra ct or t ocher proof [ha[ 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 the appli<a[i on is considered "filed" (pursuant [o RULE I.I(10) wi [h [he Hined land Reclamation Division, notice procedures outlined in RULES j.2 :/or 4.2 must be followed. (FO rmac for such notices will 6e included in [he letter you receive from [he MLR staff ___ -i_n fo stns „vu_ef •hn__- p.i=eness _nic; I isul- o.°- ... -ii-S-i-~:i~i _ _~ :___ __~ _ _ _ -__. __ _ .. ` _ _ __ __ ___ _,1DOIT ION PI-I!1F ORHATI ON -~ _ --_ ,_ _ ____ _ _ -_^_ - _ _ - _ This space can be referenced for further information of any of [he items on this form. 1 To Che best of my knowledge, all the information presen[~n [his~ca~is true and correct. Hard7d F. Fl stn Car~`y Signed by individual legally au tK izpd Co bind the operator to this app!ica[i0n.)