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<br />-4- <br />12. <br />13. <br />Cropland(CR) X Pastureland(PL) General Agriculture(GA) <br />Rangeland(RL) Forestry(FR) Wildlife Habitat(WL) <br />Residential(RS) _ Recreation(RC) Industrial/Commercial(IC) <br />Developed Water Resources(WR) Solid Waste Disposal(WD) <br />1 W? <br />® <br />Cropland(CR) <br />d <br />RL <br />l <br />F? Pastureland(PL) <br />t <br />(FR) <br />F General Agriculture(GA) <br />Wildlife Habitat(WL) <br />( <br />) <br />Range <br />an ores <br />ry <br />Residential(RS) F? Recreation(RC) Industrial/Commercial(IC) <br />Developed Water Resources (WR) L-J Mining (MN) <br />14. If this operation will use designated chemicals, or willresult, or presently has acidmine drainage- you cannot-use this application <br />-form. You must submit either a 110d or 1I2d application farm for Designated Mining Operations. In either case, you must list <br />any acidic or toxic-forming materials, exposed or disturbed as a result ofthe mining operation, .and whether the operation will <br />result in or presently has acid mine drainage: <br />15. Description of Amendment or Conversion: <br />I ryou are amending or converting an existing operation, provide a brief narrative describing the proposed change(s): <br />N/A <br />Maps & ExWbits: <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 E CHIBIT D - Reclamation Plan <br />6.15 EXHIBIT E - Maps, to include the location of any recorded easements <br />6.3.6 EXHIBIT F - List of Other Permits aadd Licenses Required <br />6.3.7 EXHIBIT G - Source of Legal light-o-Enter <br />6.3.8 EXHIBIT H - Municipalities Within a Two-mile Radius <br />6.3.9 EXHIBIT I - Proof ofFiling with county Clerk <br />6.3.10 EXHIBIT J - Proof of Mailing Notices of Permit Application <br />6.3.12 EXHIBIT L - Permanent lean: lade Strucu res <br />1.62(1)(b) ADDENDUM 1- Notice Requirements (sample enclosed) <br />6.5 Geotectuucal Stability Exhibit (as required)