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-4- <br />12 <br />13 <br />Cropland(CR) Pastureland(PL) General Agriculture(GA) <br />$cangeland(RL) Forestry(FR) Wildlife Habitat(WL) <br />Residential(RS) _ Recreation(RC) Industrial/Commercial(IC) <br />Developed Water Resources(WR) Solid Waste Disposal(WD) <br />Cro <br />la <br />d(CR) P <br />l <br />d ® <br />p <br />n <br />Ran <br />eland(RL) asture <br />(PL) <br />an <br />F <br />t <br />FR <br />? General Agriculture(GA) <br />g ores <br />ry( <br />) Wildlife Habitat(WL) <br />Residential(RS) O Recreation(RC) lndustrial/Commercial(IC <br /> E <br />Developed Water Resources (WR) Mining (MN) <br />14. If this operation will use designated chemicals, or will result, or presently has acid mine drainage -you cannot use this application <br />form. You must submit either a 110d or 112d application form for Designated Mining Operations. In either case, you must list <br />any acidic or toxic-forming materials, exposed or disturbed as a result of the mining operation, and whether the operation will <br />result in or presently has acid mine drainage: <br />/14 <br />15. Description of Amendment or Conversion: <br />If you are amending or converting an existing operation, provide a brief narrative describing the proposed change(s): <br />Qhn e /-) o%r) (-? ez'x rv e r) -/- p e?sn ,, J- ?d o c%/ el C /S <br />c? c ? ?e S <br />7D nveC'/ Gtcmc(CjC- <br />Maps & Exhibits: <br />Submit two (2) complete, unbound copies of the following application exhibits: <br />6.3.1 EXHIBIT A - Legal Description and Location Map <br />6.3.2 EXHIBIT B - Site Description <br />6.3.3 EXHIBIT C - Mining Plan <br />6.3.4 EXHIBIT D - Reclamation Plan <br />6.3.5 EXHIBIT E - Maps, to include the location of any recorded easements <br />6.3.6 EXHIBIT F - List of Other Permits and Licenses Required <br />6.3.7 EXHIBIT G - Source of Legal Right-to-Enter <br />6.3.8 EXHIBIT H - Municipalities Within a Two-mile Radius <br />6.3.9 EXHIBIT I - Proof of Filing with County Clerk <br />6.3.10 EXHIBIT J - Proof of Mailing Notices of Permit Application <br />6.3.12 EXHIBIT L - Permanent Man-Made Structures <br />1.6.2(1)(b) ADDENDUM I - Notice Requirements (sample enclosed) <br />6.5 Geotechnical Stability Exhibit (as required)