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RECLAMATION PLAN APPLICATION Planning Division Case No.: 38250 Sierra Highway Palmdale, CA 93550 Date: (661) 267-5200 [EMAIL REDACTED] Received By: INSTRUCTIONS TO APPLICANT The following application form is provided for all applicants requesting a Reclamation Plan with the City of Palmdale. The applicant must complete the attached form as prescribed and submit the following information before the application can be accepted by the Planning Division. SUBMITTAL CHECKLIST ALL MAPS MUST BE FOLDED BY APPLICANT TO A MAXIMUM 8 ½” x 11” SIZE. The completed Application. A copy of the Development Advisory Board (DAB) letter (if applicable). A Title Report for the subject property prepared within the last six months which includes a declaration of all easements of record and copies of all easement/declaration instruments referenced. Note: Preliminary Subdivision Reports are not acceptable. 2 sets of property owners (including APN) and occupants mailing labels (self- sticking) within 500 feet of the subject property. Include all other persons to be notified. Labels must be numbered sequentially and cross-referenced to the radius map. See attached example of mailing labels. A copy of the mailing labels in tabular form. A radius map showing the subject parcel(s), nearest major cross-streets, all properties within 500 feet of the boundaries of the subject parcel(s), and indicating the Assessor’s Parcel Number of every parcel within or touching the radius line. All parcels must be cross-referenced to the mailing list. The original Certified Property Owners List Affidavit. ---PAGE BREAK--- The original Public Hearing Sign Removal Authorization. The original Letter of Authorization and attached legal description of the property. The original Hazardous Waste Certification. A vicinity map at a scale clearly indicating the subject parcel(s) and showing the existing major street patterns, zoning and land use designations, and actual land use projects, subdivision(s), creeks, railroads and other significant landmarks) within a minimum of one mile of the exterior boundaries of the site on 8 ½” x 11” paper. Note: Thomas Guide maps are not acceptable. A transparency of the above vicinity map. 25 copies of the Reclamation Plan. State Mining and Geology Board Reclamation Standards are required. Pursuant to the California Environmental Quality Act, the Planning Division will review the project and determine areas of potential environmental impact. Special studies including, but not limited to traffic, biological, noise and archaeological may be required. This information may also be obtained through preliminary project review by the Development Advisory Board (DAB). FEE CALCULATIONS** Base Fee: $ 2,000 @ $20/acre # of acres: Initial Environmental Study: 625 City of Palmdale Fish and Game Processing Fee: 25 @ $1.65 / label: # of labels *City Attorney Deposit Fee: 2,000 TOTAL FEE RECEIVED: *Note: City Attorney fees to be paid from this account. Additional fees to be billed. **Additional City, State and/or County fees will be required prior to project approval. Fee calculations may vary if case is submitted concurrently with other cases. ---PAGE BREAK--- APPLICATION FOR RECLAMATION PLAN Pre-Application Number: Case No.: Request to approve a Reclamation Plan for a acre surface mining operation. Existing Land Use: Project Location: (Address if Applicable) Assessor’s Parcel Number(s): Approximately Feet N or S of (Circle) (Street Name) Approximately Feet E or W of (Circle) (Street Name) List all related project case numbers (current applications, previously submitted, and/or previously approved cases): APPLICANT: Name: Address: City: State: Zip: Email: Telephone No.: ( ) Fax No.: ( ) OWNER: Name Address: City: State: Zip: Email: Telephone No.: ( ) Fax No.: ( ) ENGINEER/REPRESENTATIVE: Name Address: City: State: Zip: Email: Telephone No.: ( ) Fax No.: ( ) Use additional sheets in the case of multiple parcel numbers, owners, etc. Also, please include in mailing list all other persons to be notified regarding this application. ---PAGE BREAK--- OWNER AUTHORIZATION LETTER Case Number(s): Assessor’s Parcel Number(s): If the applicant is not the owner of record, then a letter authorizing the applicant to represent the owner(s) must be submitted. Note: All owners must sign as their names appear on the deed to the land. This letter shall serve to notify and verify that I/we am/are the legal owners of the property described and attached hereto and do hereby authorize the applicant to file and represent my/our interest in the above referenced applications(s). I/we have read this Letter of Authorization and know the contents thereof; and so hereby certify (or declare) under penalty of perjury under the laws of the State of California that the information contained in the above referenced application(s) is true and correct. OWNER(S) OF RECORD (Include extra sheets if necessary): Printed Name Signature Date Printed Name Signature Date I certify under penalty of perjury that I am the applicant and that the foregoing statements and answers herein contained and the information herein submitted, are in all respects true and correct. APPLICANT / APPLICANT’S REPRESENTATIVE: Printed Name Signature Date Address Telephone Printed Name Signature Date Address Telephone Subscribed and sworn to before me this day of NOTARY PUBLIC NOTE: ATTACH LEGAL DESCRIPTION OF PROPERTY TO THIS DOCUMENT. ---PAGE BREAK--- CITY OF PALMDALE PLANNING DIVISION HAZARDOUS MATERIALS / WASTE PRODUCTS CERTIFICATION Pursuant to Section 65962.5(e) of State Government Regulations, project applicants must identify whether a project site contains any hazardous materials and/or wastes included on any list compiled by the State Department of Health Services, the State Water Resources Control Board or the California Integrated Waste Management Board or are known by the owner or applicant. These lists generally identify sites that have pending corrective action regarding leaks or migration of hazardous materials. CERTIFICATION I have consulted the list compiled pursuant to Section 65962.5 of the Government Code and hereby certify that the project site and any alternatives to the project are are not identified on any of these lists. I further certify that, to the best of my knowledge, there are are not such hazardous materials on this site. Assessor’s Parcel Number(s): Case Number(s): Project Location (address if available): Approximately Feet N or S of (Circle) (Street Name) Approximately Feet E or W of (Circle) (Street Name) Use additional sheets if necessary. Date Owner’s Signature Date Owner’s Signature Date Applicant’s Signature If the site is listed, which listing agency has identified the site? If the site is listed, what is the Regulatory Identification Number associated with the site? NOTE: Before the Lead Agency can accept the application as complete, this certification must be reviewed and signed by the project owner(s) and applicant. ---PAGE BREAK--- CITY OF PALMDALE PLANNING DIVISION PROPERTY OWNERS CERTIFICATION Case Number(s): I certify under the penalty of perjury that on the day of the attached property owners list contains the names and addresses of persons to whom property is assessed as they appear on the latest available equalized assessment roll of the County of Los Angeles within the subject property and for the parcels within 500 feet of the boundary of the subject property. PLEASE PRINT ALL INFORMATION EXCEPT SIGNATURE. Name: Title: Company: Address: Phone: ( ) Signature: Date: ---PAGE BREAK--- LEAVE THIS AREA BLANK Applicant’s Name Address City, State, Zip Code THIS FORM MUST BE USED TO CREATE MAILING LABELS. Use the following format: Owner’s Name Address City, State, Zip Code Assessor’s Parcel No. Name Address City, State, Zip Code Representative / Engineer Name Address City, State, Zip Code ---PAGE BREAK--- APPLICATION SUPPLEMENT FOR SURFACE MINING USE PERMIT AND RECLAMATION PLAN 1. Applicant: Name: Address: City: State: Zip: Telephone: Fax: Property Owner: Name: Address: City: State: Zip: Telephone: Fax: Owner of Mineral Rights: Name: Address: City: State: Zip: Telephone: Fax: Mine Operator: Name: Address: City: State: Zip: Telephone: Fax: 2. Assessors Parcel Number(s): 3. Legal Description of Property: 4. Present Use of the Site: 5. Present Land Use in the Vicinity of the Site: Mining Operation Information 6. Proposed Starting Date (or Date Operation Began): ---PAGE BREAK--- Proposed Termination Date: 7. Describe the Mineral Commodity(ies) to be Mined: 8. Approximate Quantity of Mineral Commodity to be Mined: Annually cu. yds. / tons (circle one) Project Total cu. yds. / tons (circle one) 9. Approximate Quantity of Overburden to be Mined: Annually cu. yds. / tons Project Total cu. yds. / tons 10. Explain the Mining Methods Proposed (open pit, dredge, etc.): 11. Describe all Processing to be Done On-Site (including equipment used): 12. Describe Proposed Use of Mined Material(s): 13. Will Operations be: Continuous Intermittent Explain: Seasonal Explain: ---PAGE BREAK--- -10- 14. Amount of Surface Area to be Disturbed by Mining Operations Including Extraction, Processing, Stockpiles, Access/Haul Roads, Offices, Etc.: Annually: acres Each Phase: acres Total: acres 15. Maximum Anticipated Depth of Mining Activities (measured from pre-mined surface): feet. 16. Number of Average Daily Truck Trips Anticipated: Maps/Diagrams Required All required plans shall be prepared accurately by a qualified individual registered civil engineer, licensed architect, licensed building designer), drawn to a standard engineering scale 1”=20’, 1”=50’, 1”=100’, 1”=200’), or architectural scale 1/8 that is appropriate to the project size and able to clearly define and identify all required information. Submit at least one set of all maps on paper no larger than 11” by 17” to facilitate reproduction. 17. Submit maps drawn to scale showing: a. Boundaries of the affected lands; b. Vicinity map showing general location of the site; c. Topography of the area and the site with detail of mined lands; d. Location of existing land features including streams, drainages, ponds/lakes, wet areas, roads, railroads, utility buildings and existing significant ground disturbance, on and immediately adjacent to the site; e. Location of new access/haul roads to be constructed; f. Delineation of areas within the site proposed for: 1. excavation/pit; 2. waste dumps; 3. materials stockpiles (including stockpiled top soil or other growth media intended to be used in reclamation); 4. materials processing; 5. siltation ponds (if proposed), and other sediment control facilities; 6. equipment maintenance/storage; 7. structures; 8. utilities; 9. wells g. Map(s) and cross-section(s) of mining site including contours before mining and after reclamation. Indicate existing and proposed maximum slope ratios after reclamation. h. Copy of Assessors map(s) showing the entire site. 18. Attach a description of the geology of the area generally surrounding the mine site, and a detailed description of the geology of the mine site itself. ---PAGE BREAK--- -11- 19. Describe, in detail, the pre-mine biophysical characteristics of the project site and explain how these characteristics relate to surrounding lands. Emphasis should be on vegetation, wildlife, known rare, endangered and threatened species of plants and animals occurring on the site or in the vicinity, wet areas, and surface drainage system(s). Refer to and include copies of any reports, surveys, and other documentation used in your description. If mining or other ground disturbing activities have already taken place, the characteristics of similar lands adjacent to the mine site may be used. 20. Provide a time schedule of proposed mining activities on each segment of mined lands or each phase of the operation. 21. Provide a detailed description of the proposed use or uses of the mined lands after mining activities have ended and reclamation is complete. Refer to the City’s surface mining and reclamation procedures, available from the City of Palmdale Planning Division, and attach any supporting documentation applicable to the proposed end use. 22. Describe how reclamation if mined lands will be accomplished. This section should address at least the following: a. reclamation techniques that will be used to accomplish the proposed end use; b. storage and protection of top soil or other growth media; c. resoiling or other techniques to provide viable growth media on disturbed lands; d. control of contaminants, if any; e. erosion control during and after mining activities; f. disposition of mining wastes; g. protective measures against contamination of surface and ground water. Include Regional Water Quality Control Waste Discharge and/or NPDES permit number(s); h. rehabilitation of any affected streambeds, banks, channels, drainages; i. reshaping/contouring disturbed lands – stabilization of mined slopes, waste dumps, tailings, road cuts, etc.; j. revegetation of disturbed lands with species appropriate for the site and the proposed end use; k. protective measures for long term mitigation of hazardous conditions (highwall stability, cut/fill slopes, etc.); l. reclamation time schedule (related to each segment of mined lands or phase of operations); m. disposition of equipment used in all phases of operation. 23. Provide a statement describing how reclamation of this site in the manner proposed will affect future mining in the area. Financial Assurances 24. Upon approval of the surface mining permit and reclamation plan, and prior to issuance of an “Authorization to Operate”, financial assurance(s) ensuring that reclamation is performed in accordance with the approved reclamation plan must be submitted to and approved by the City of Palmdale. Assurances may take the form of surety bonds, irrevocable letters to credit, trust funds, certificates of deposit, or other forms of financial assurance acceptable to the State Department of Conservation and the City of Palmdale. The financial assurance shall ---PAGE BREAK--- -12- remain in effect for the duration of the surface mining operation and any additional period, to be determined by the lead agency, until reclamation is determined to be complete. The amount of the financial assurance shall be sufficient for the lead agency to hire an independent contractor to perform reclamation according to the approved plan in the event that the mine operator/permittee defaults on reclamation. It is the responsibility of the mine operator/permittee to provide estimates of the cost of carrying out reclamation according to the approved reclamation plan to the City of Palmdale in order to determine the amount of the reclamation bond. Estimates must be prepared by a qualified third party not otherwise employed by the mine operator. Such person may be a registered engineer, registered geologist, or other person with similar qualifications who is familiar with reclamation techniques and associated costs. Financial assurances shall be made payable to the City of Palmdale and Department of Conservation. Financial assurances, along with copies of the third party estimate of costs must be submitted to the City of Palmdale for review and approval prior to issuance of the “Authorization to Operate”. Reclamation assurance may be subject to annual review and adjustment in consideration of operation compliance, inflation, reclamation already performed, etc. Statement of Responsibility I, do hereby accept full responsibility for reclaiming the lands herein described in accordance with the approved reclamation plan for this operation, and the conditions imposed by the City of Palmdale as lead agency. (Signature) (Date) (Position/Relationship to Operation) ---PAGE BREAK--- -13- CITY OF PALMDALE PLANNING DIVISION PROCEDURES FOR PROJECT SITE SIGN POSTING In order to increase public awareness of pending development proposals requiring public hearings, the City of Palmdale has included “Project Site Sign Posting” in its public hearing notice procedures. The applicant of a proposed project scheduled for a public hearing before the city Council, Planning Commission, or Planning Manager is required to post a sign with public hearing information, which will be visible to the public right-of-way from the subject site. Late or inaccurate sign posting will cause postponement of the public hearing for the case. CASES REQUIRING SITE PLAN POSTING: Conditional Use Permits General Plan Amendments Site Plan Reviews Specific Plans Subdivisions Variances Zone Changes Amended or Revised Cases of any of the above Annexations Land Divisions Prezone Changes SIGN SPECIFICATIONS: 1. SIZE: Dimensions shall be four feet by eight feet. 2. HEIGHT: Sign shall be six feet in height. 3. MATERIALS: ½ inch plywood (minimum). Sign shall be constructed with 4” x 4” supporting posts placed at a minimum depth of two feet with 2” x 4” cross supports as shown in the diagram. 4. LOCATION: NOT LESS THAN FIVE feet inside the property line in residential zones, and not less than one foot inside the property line in commercial and industrial zones. Shall be located in the area most visible to the public on the project site. 5. COLOR: Black letters on white background. 6. LETTERING: Shall be block style with 4” major letters and 2” minor letters. 7. LIGHTING: Shall NOT be illuminated. 8. Only one sign may be displayed per street frontage of the site. A site which is not visible from an existing street or not adjacent to an existing development MAY be ---PAGE BREAK--- -14- exempted from the site plan posting requirement at the discretion of the Planning Manager. 9. Sign shall include ONLY the information provided by the assigned planner. If it becomes necessary to revise the information required on the sign, such as a change in the number of lots or square footage of buildings, it shall be the responsibility of the applicant to obtain approval of such revision(s) from the assigned planner. 10. Sites with multiple cases shall combine the information for each case on the sign. SIGN SCHEDULE: 1. Sign shall be posted no less than fifteen (15) days prior to the hearing date. It shall be the responsibility of the applicant to contact the Planning Division to obtain the appropriate date and time. 2. Hearing date on the sign shall be changed for Commission items which are continued or are to be heard by the City Council including, but not limited to, Zone Changes, General Plan Amendments, Specific Plans, and appealed items. Said date shall be changed a minimum of eleven (11) days prior to the hearing. 3. Sign shall be removed within sixteen (16) days following the Planning Commission hearing date or IMMEDIATELY following final City Council action. It is recommended that the cost of sign removal be included in a sign contract with the sign company. ---PAGE BREAK--- -15- CITY OF PALMDALE PLANNING DIVISION PUBLIC HEARING SIGN REMOVAL AUTHORIZATION Case Number(s): Assessor’s Parcel Number(s): Location (address if available): Approximately Feet N or S of (Circle) (Street Name) Approximately Feet E or W of (Circle) (Street Name) By this signature, I acknowledge that I understand the requirements for posting the subject property for public hearing and do agree to pay all costs for the removal and storage of said public hearing sign if it is not removed within 16 days of the final hearing for this/these case(s). Applicant/Agent: Date: Owner: Date: