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TYPE OR PRINT CLEARLY <br />14. Present land use p~-icultural, unimproved gram ng dry <br />(i. e., egricultuzal, industrial, etc.) „„p„~,„d_ <br />15. Proposed future land use Agriculturol, unimproved gracing, dry <br />(Coal o£ reclamation) ra„vein„r. <br />INSTItUCTI0R5: This application form moat be submitted in duplicate and each form moat <br />be accompanied by the following iafarmatian and Stems. The application <br />will mt be processed until complete. Sea RULE g (for Limited Impact) <br />or RULE 4 (for Special 10-day) Far additional guidance. <br />ERFIIBIT A - Legal -escrintion. <br />The legal description must ideatifg,the aFfecced land and be wholly adequate fur <br />field location of [he property. It can be .ia the form of metes and bounds survey <br />or a deecrip lion by refereaee to township, range, and section to at least the . <br />nearest quaztar quarter section. Idhere applicable, the street address or lot . <br />number(s) may be used. <br />P1CiIBIT H - :Lining Plan <br />This can be a general discussion of the methods, equipment, phases or stages of <br />the operation and [hose portions of land of fecled bq each. The plan should be <br />closelq correlated with the map and should show where extraction will begin, which <br />direction it mill proceed. <br />E%RIBIT C - Map <br />This map should be as comprehensive as possible in terms of clearly defining <br />the permit boundaries and indicating all roads or stockpile areas to be used is <br />connection with the operation. All immediately adjacent landowners must be ehoan. <br />The closest quarter section corner, section line, or say other locateab le po eat <br />should also be shown on the map. <br />EXRIBLT D - Wildlife, Water Resources, Vegetation and Soils Infermatlon <br />Teach of the above-mentiaaed subj ecta must be addreeaed as outlined in the <br />applicable Rule, under item number ten (10). <br />P}AIIBIT E - Reclamation Plaa <br />As with [he mining plan, this should be a general des cuasion of Che methpda, <br />equipment, phases or stages of Che reclamation process sad those portions of <br />land affected by each. If possible, the plan should 6a cleanly correlated <br />with the map. If ao t, the narrative must be comprehensive enough to drEO+ an <br />accurate verbal picture of the expected phyaical~appeazanee of the area after <br />completion of reclamation. <br />E1103IIBIT F - Proof of Local Government Approval <br />This must be a letter from the local government specifying canformaaee with <br />existing saning regulations. <br />EAiIBIT G - Source of Legal Rieht to Enter <br />Thin could De a copy of the lease, deed, abstract of title, or cnrrcnt tar <br />receipt. Ia lieu thereof, a statement acknowledged by a notary public that <br />the operator has the legal right to eater and mine will be accepted. <br />**FDA SPECIAL 10-DAY PERMITS ONLY** <br />E%HIHIT H - Reclamation Costs <br />If the surety is requested to be less than $2500, the operator must submit <br />facts Co support such request. Otherwise a surety of $2500 will automatically <br />be sat. <br />$RRIeIT I - Tarns of Governmental Caatrad <br />The operator moat submit a copy of the eonCYacC or other proof that proves the <br />nece9aicy of a spacial 10-day parmlt. The operator must also submit evidence <br />of the surety provided under the governmental contract, if it was required. <br /> <br />90m 'tl u~9S .0i kN/80/ZS L84b8Z0008 tlnF18 .11l~O Nn9X]tlC <br />