2012-02-21_REVISION - M1977443 (4)

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12. 13. P 6.3.1 6.3.2 6.3.3 6.3.4 6.3.5 • 6.3.6 6.3.7 M/4 6.3.8 6.3.9 6.3.10 6.3.12 1.6.2(IXb) 6.5 fu d use ropland(CR) Rangeland(RL) Residential(RS) Developed Water Resources(WR) nt land h ck on ropland(CR) Rangeland(RL) Residential(RS) Developed Water Resources (WR) Allen/4 /.1>d- F6/q q, y'`4r.", - 4 - Pastureland(PL) Forestry(FR) Recreation(RC) Pastureland(PL) Forestry(FR) ®Recreation(RC) General Agricuhure(GA) Wildlife Habitat(WL) Industrial/Commercial(IC) Solid Waste Disposal(WD) General Agriculture(GA) Eil Wildlife Habitat(WL) Industrial/Commercial(IC) Mining (MN) 14. If this operation will use designated chemicals, or will result, or presently has acid mine drainage - you cannot use this application form. You must submit either a 110d or 112d application form for Designated Mining Operations. In either case, you must list any acidic or toxic - foaming materials, exposed or disturbed as a result of the mining operation, and whether the operation will result in or presently has acid mine drainage: NoN e 15. Description of Amendment or Conversion: If you are amending or converting an existing operation, provide a brief narrative describing the proposed change(s): M /tip r uY- - f P gari/v.1 jzy k , poii. Maps & Exhibits: Submit two (2) complete, unbound copies of the following application exhibits: EXHIBIT A - Legal Description and Location Map EXHIBIT B - Site Description EXHIBIT C - Mining Plan EXHIBIT D - Reclamation Plan EXHIBIT E - Maps, to include the location of any recorded easements EXHIBIT F - List of Other Permits and Licenses Required EXHIBIT G - Source of Legal Right -to -Enter EXHIBIT H - Municipalities Within a Two-mile Radius EXHIBIT I - Proof of Filing with County Clerk EXHIBIT J - Proof of Mailing Notices of Permit Application EXHIBIT L - Permanent Man -Made Structures ADDENDUM 1 - Notice Requirements (sample enclosed) Geotechnical Stability Exhibit (as required)