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~ ~ ~ ~; ' 110 Permit Anpliration (c on['d) L+S'IItUCTI0N5: This application and all accompam•Lng materials must be satnni[ted Sn I duplicate. In the interests of efficient processing, pleasa include ' the following Snforma aen ~ Stc ;,. Limited Zmpace Cpc:cC'_cnc, cce .°.^L°_ 3 for guidance; Special 10-day Perml[s, see RULE 4 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 S bounds survey or a descrip- tion by reference to township, range, and section, to at least the nearest quarter- quarter section. Where applicable, [he street address or lot number(s) my be used. EXHIBIT B - Mining 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, St will proceed. EXHIBIT C - Hap This map should clearly define p~raalt boundaries and indicate all roads or stockpile areas to be used in connection vit:h~~the operation. All immediately adjacent landowners must be 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-mentioned subj ec:ts 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 oc stages of [he reclamation process and those portions of land affected by each. If possible, [he plan should be closely correlated with the map. If not, [he narrative ` must be comprehensive enough to dray an accurate verbal picture of the expected appear- ance of the area after completion of reclamation. EXliIBIi F - Proof of Local Government Approval This must be a letter from the local government specifying conformance with existing zoning regulations. (It is intended [hat operators may obtain local government approval concurrent with the Division's processing of the application. io do so, the operator must submit evidence which indicates that local government approval Ss currently pending or will at least be considered within a reasonably short Cime by the appropriate govern- ing body RULE 1.1(10) (Consult this RULE for full details on this requirement.) ERHIBIT G - Source of Legal Right 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 [he 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 ooeratormust submit facts to support such a request. 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 Specidl 10-Day (111) Permits, the operator must submit a copy of th¢ 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 vas required. NOTICE PROCEDURES After the application is considered "filed" (pursuant to RULE 1.1(10) with the Mined Land Reclamation 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 [he ;1LR staff informing you of the completeness ("filing") of your application. ADDITIONAL INFORMP,TION This space can be referenced for further Information of any of the items on this form. To the bast of my knowledge, all [lie information present Sn [his applies on is Crue and correct. i BY ~ //~~ r1rLE DPSR~kTnGt (S ^::od by indi :~iJual 1:~~.illc a~uhor- iud ce bi r.d the eperator to [his applicia }Jn•i