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nlcha~d G. Lamm Governor D[PARTMENiOFNAfURALRESOURCES David 11. Celchee, E.ecullve Dlreclor MINED LAND RECLAMATION Did DAVID C. SNELTON, Dlreelor APPLICATION FORM FOR A REVISION TO A COAL MINING AND RECLAI4ATION PERidIT This form must be completed and submitted with all requests for minor revisions, as defined in Rule 1.04(13), technical revisions as defined 1n Rule 1.04(36) and permit revisions, as defined in Rule 1.04(90). All revisions are to address the requirements of Rule 2.08.4. All revisions are to be formatted so they can be inserted into the permit to replace the revised sections, maps, tables and/or figures. Explain in the revision what section is being revised. the revision date should be printed in the lower right corner of the revision pages. If necessary, the Table of Contents should also be revised. Date: U 2/ I 2/ 8 fi Permlttee: ~~~~~~~-~~~~--- Street: i _3_ ._0_ ~ - ~ - _Y..g ~ E - - - - FEB 17 1988 Ci t : MINED IANU Y ~ 1 ~ G .~ T A F F - - - - - - - -RE~t..AN1g'YION UIVIl:IC1N `~e: -A1 Zip Code: 8 6 0 0 1----- Permit No.: C- g 0- 0 0 5 This box to be F111ed 1n by the bivision: Type of Revision: _ _ (PR, TR, or FIR) Revision (lumber _ _ (Sequential by P,evislon Type) Revision Submittal Date _/_/_ (Date Received by Division) P,evlsion Completeness Date -/_/_ Revision Incompleteness Date -/_/ Revision Adequacy Due Date -/_/_ Revision Adequacy Date -/-/- Revision Decision Due Date / / Fee 1;0.00 Brief Description of Revision: ~ ~ ~ ~ ~ t 0 G Y - - - - - - 111L~1..1~....8.~ IJ G Public Notice Attached - Yes X No _(P.equired for PR's and TR's) Bond Increase: Yes No X Proposed Change In: Disturbed Area (+/-) - - Q. 0 Acres Affected Area (+/-) _ _ p .0 Acres ~it Area (+/-) - - ~.~ Acres Federal Land (+/-) - - Q . Acres State Land (+/-) p Acres Private Land (+/-) O Acres Lead Reclamation Specialist 6185E 423 Centennial Building, 1313 Sherman Slreel benver, Colorado 80203 Tel. (303) 866-3567