REP36948

• Permit No: M1981277
• IBM Index Class Name: Report
• Doc Name: LIMITED IMPACT 110 & SPECIAL 10 DAY 111 PERMIT APPLICATION FORM
• Media Type: D
• Archive: No

I
110 Pe rt:ic .4ooLi: a:'on lco• d)
L`f5?UCT10[:S: 2us applLcaclcn and all acconpnrv iae ^:a [erials rouse 6e satnnicced in
duplicate. In tic Ln ca rests o: a[_:ciza: ?ro~ass in:, c..,~ a..uda
c::e following infor-clan :. ._ca-. Yn_:ci c_ _.-._c __c °:^~
7 for guidance; Special 10-day ?ermies, see SUli. for ~gu idance.^
R:i,32'1' .1 - !e2i1 Description
'he legal descr.Lption amst ideati:y the affected laced and be ,holly adequatn for '_ield
location of the property. Lc can be is the fom of aaces v bounds surrey err a descrip-
tion by referem:a co township, range, aced section, co ac least the peacoat quarter-
quarter section. '+7 ere applicable, c4e street aadress or Ioc number(s) izy be used.
E:tY*9Ir 9 - 'riaCaq Plan
This eaa ba a g~:petal diseuasien of the anthods, egnipmeac, phases or stages of .ha
operation and c::o sa portions of land affected by each. 'I'.ie plan should Se correlated
with the nap ami should show where extraeciaa will Seger, and which di.reccion, if nay,
it will proceed.
~I3I* C - wan
::.is nap should clearly define persic bpuadaries wad indicate all roads or stockpile
areas co ba used in eonaaecioa wick the operation. All L-~ediacely adjacent laadawara
awt ba shown. She quarter section eoraar, sactiea 1~e, or nay ocher locaceable
poiacs shpuid a'.sp Sa shown on this map.
-- ~aeh b!`c!sa shove-~aaationad aabjeets sut be addressed as aucliaed is cha app11ub1•
3IILII.
°_?EI3IT °_ - 3ee::amation Plan
As with the ain:.ag plea, this should ba a general diseusaion of chn aathods, equipmeac,
ohases or stagers of the reclamation process and chosn portions of :wad affected bo each.
if possible, tin plan should be cloaaly eor..elated •rlth the nap. If not, the aarraciva "
wst Se comorahaasive enough to draw as accurate verbal picture of the ao:pecced appear-
ance of the area alter eatapleeion pf reelamacian.
~~3I'C P - ?-oaf of Kcal Cwe:-~ent Anprpoal
Phis ....t Se a ].error f-om the local gover:~enc spec"yiag canformaaea with e>`stiag
toniZg regnlac'_crns. (It is lacended that operators nay obtain local 3overimeac approval
coacar_enc :Y th the Division's ?recessing of the application. So do so, the operator
wst submit evidxaea which iadieaees that '_acal govetamenc approval '_s cur. encly pending
or vial ac least: Sa considered :richia a reasonably short ti~a Sy the appropriate 3ooera-
iag Sody S'T'TO 1.1(IO) (Capsule this 2D'I.E far fu11 decaL's oa this regvirexanc.)
~~r - Source of i.a¢al 31¢ht eo Eater
'Bice could be a copy of the'Lease, deed, abaeract of ciele, err cur-_ent tax :eenipc.
Ace acceptable al.cernacive :could be a scaczaeac aekaovledged by a aacary puhlic chat
cha oneramr Sa:. the 1ega1 ri;hc co eater wad aloe.
r"i,iT92? R - 2e^_J.3=acian Casts
rot a 1_0 parcel::, ,; ehe operator :equal cs surer? co be less than S?500, the operate roust
submit `acts to support such a raeuesc. Otherrlsa, a surety of 5:500 vi'-1 auc_^nat'_cally
be sac. rot all. '_I1 per3i.cs, the suracy sha11 be.5Z5C0 per acre.
I': - 'e^_ts of Cover~ental Contracts
eor Special 10-Clay (Ill) Permies, the operator mwc su'omit a copo of :he contract or
ocher proof chat oroves the naeusity of a spacial 10~isy persic. roe operator oust
also submit evldeaea of the surety provided uadar Cha ;overnmencal contract, if is xis
required.
YOYICE P30C~URES
:firer the application is considered "filed" ;pursuant co ZDL 1.1(:0) •rich the :!Stied
Land 3aelamaciet. Civ'_sion, aotlce procedures outlined is ZDI.ZS 7.2 wad/pr ~.? wsc be
faI'_oved. (cor_uc for such notices vLl Sa iaeiuded in the lector you receive from the
723 seat? lafar_~1ag you of cha eeapleceness ("filing") of your apglicacipn.
.iDDI'ICSAL T_`7i'CQ:L4IICN
:his space can :a referenced for'further lafortucion of any pf toe items on ri:a fora.
'o the Sesc of ay isovLedge, all :he is.araacion presented in t...s appilcacioa is c.-ae
and tor-. ee:.
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