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~ oF'~~< <br />~~ o,~ <br />o DEPARTMENT OF NATURAL RESOURCES <br />~ '~ .~ ~ ~i' * David H. Getches, Executive Director <br />* ~'~='"~ MINED LAND RECLAMATION DI\ <br />~ X876 ~ DAVID C. SHELTON, Director <br />Richard D. Lamm <br />Governor APPLICATION FORM FOR A REVISION <br />TO A COAL MINING AND RECLAMATION PERMIT <br />This form must be completed and submitted with all requests for minor revisions, as <br />defined in Rule 1.04(13), technical revisions as defined in Pule 1.04(36) and permit <br />revisions, as defined in Rule 1.04(90). All revisions are to address the requirements <br />of Rule 2,08.4. <br />All revisions are to be formatted so they can be inserted into the permit to replace the <br />revised sections, maps, tables and/or figures. Explain in the revision what section is <br />being revised. The revision date should be printed in the lower right corner of the <br />revision pages. If necessary, the Table of Contents should also be revised. <br />Date: 0 8/ 1 tl/ $ i ~ ~' ~~'~ <br />,~- <br />Perini ttee : p <br /> <br />c E A <br /> <br />o M B 0 O <br /> <br />p A r~ Y C O A L <br /> <br />Y_-_- <br />- <br />- <br />- <br />-- . <br />. ~. ~ ~ °~ <br />r~uG ~.1~9$7. <br />Street: 1 3 0 0 S _ <br />_ <br />_ <br />_ <br />__ <br />O U T H Y A L E ~,~i,~i~.L~ L.:~~I~ <br /> <br />City: - <br />F <br />- - - <br />L A <br />- - - - - <br />G S T <br />- - - - - - - - - - - - <br />A F F <br />- - - - - - - - - <br /> <br />- - - - - <br />State: A Z Zip Code: $ 6 0 U i - _ <br />_ _ <br />Perini t No.: C - cs 0- U _ <br />U 5 <br />This box to be filled in by the Division: <br />Type of Revision: (PR, TR, or MR) <br />Revision Number - - (Sequential by Revision Type) <br />Revision Submittal Date -/ / (pate Received by Division) <br />Revision Completeness Date -/ / Revision Incompleteness Date _/_/ <br />Revision Adequacy Due Date -/ / Revision Adequacy Date _/_/_ <br />Revision Decision Due Date / / Fee $0.00. <br />Brief Description of Revision: 7 7 <br />- - U D R A <br />- - - - - G L I <br />- - - Id E <br />- - - <br />- - <br />D <br />- E A D <br />- - - H E A D <br />- - - R O U i E <br /> <br />Public Notice Attached - Yes <br />No X - - <br />(P,equired for - - - <br />PR's and - - - <br />TR's) - - <br />Bond Increase: Yes No X <br />Proposed Change in: <br />Disturbed Area (+/-) - - ~.~ Acres Affected Area (+/-) _ _ 0. U Acres <br />Permit Area (+/-) - - U. 0 Acres Federal Land (+/-) _ _ U Acres <br />- State Land (+/-) - - ~ Acres Private Land (+/-) 0 Acres <br />Lead Reclamation Specialist 6185E <br />423 Centennial Building, 1313 Sherman Street Denver, Colorado 80203 Tel. (303) 866-3567 <br />