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4~~ <br />.•` COLORADO DIVISION OF MINERALS AND GEOLOGY <br />•~.~. • 1313 Sherman Street, Room 215, Denver, Colorado 80203, (303) 866-3567 <br />RECE/V~~- <br />APPLICATION FORM FOR A REVISION JAN 13 2003 <br />TO A COAL MINING AND RECLAMATION PERtMort~nrwra~sBGeolo9Y <br />This form must be completed and submitted with all requests for minor revisions, as defined in Rule 1.04(73), <br />technical revisions, as defined in Rule 1.04(136), and permit revisions, as defined in Rule 1.04(90). All revisions <br />are to address the requirements of Rule 2.08.4. Three (3) copies of the revision, including maps, must be <br />submitted in order for it to be complete. <br />All revisions are to be formatted so they can be inserted into the permit to replace the revised sections, maps, <br />tables andlor figures, with a revised table of contents, if necessary. The revision submittal date should be printed <br />in the lower right corner of each revision page. A cover letter to the revision should explain the nature of the <br />revision and reference the specific permit sections being revised. <br />For federal mines, a copy of the revision application must be submitted to all agencies on the federal mailing list <br />(except OSM) at the same time the application is submitted to the Division, and proof of distribution must be <br />submitted to the Division along with the application. Copies of revision pages modified during the review process <br />must be distributed in the same manner, along with proof of distribution. Proof of distribution must be submitted <br />prior to implementation of the revision. <br />Permit No.: C - 81 - cz2 Date: 01 / O8 / 2003 <br />Permittee: Oxbow Mining LLC <br />Street: P.O. Box 535, 3737 Hwy 133 <br />City: Somerset <br />State: Co~ Zip Code: 81434 _ <br />Brief Description of Revision: MR-65 -- Correction to Permit Area Description <br />Public Notice Attached: Yes _ No /. (Required for PRs and TRs) <br />Bond Increase: Yes No `~ Federal / Non-Federal Mine <br />Proposed Change in: <br />Permit Area - <br />Disturbed (+/-) _ _ c _ Acres <br />Permit (+/-) _ _ o . _ Acres <br />Affected (+/-) _ _ ~ _ Acres <br />Mineral Ownership - <br />Mineral Private (+/-) _ _ 0 . -Acres <br />Mineral Federal (+/-) _ _ ~ _ Acres <br />Surface Ownership - <br />Private Land (+/-) _ _ o _ Acres <br />Federal Land (+/-) _ _ o . _ Acres <br />State Land (+/-) _ _ ~ _ Acres <br />Mineral State (+/-) _ _ ~ _ Acres <br />