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III IIIIIIIIIIIIIIII <br />999 <br />DIVISION OF MINERALS AND GEOLOGY <br />Department of Natural Resources <br />1313 Sherman 51., Room 215 <br />Denver, CO 80201 <br />Phone: 1303) 866-3567 <br />FAX: 13031832-8106 <br />~t~-~-~ <br />pF' COQ <br />~;. <br />JUN 21994 :~~ <br />~~~876• <br />Chne.!cn CI r4111L'I LIS h UtCN~~y <br />Roy Romer <br />Governor <br />APPLICATION FORM FOR A REVISION Michael B. Lang <br />TO A COAL MINING AND RECLAMATION PERMIT DivisionDnector <br />This form must be completed and submitted with all requests for minor revisions, as defined in <br />Rule 1.04(731, technical revisions, as defined in Rule 1.04(361, and permit revisions, as defined <br />in Rule 1.04(90). All revisions are to address the requirements of Rule 2.08.4. Three 13) <br />copies of your revision, including maps, must be 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 <br />sections, maps, tables and/or figures. Explain in the revision what section is being revised. <br />The revision date should be printed in the lower right corner of the revision pages. If <br />necessary, the Table of Contents should also be revised. When the final version of the revision <br />is approved, seven copies must be sent to OSM in Denver for federal mines; for non-federal <br />mines, one copy must be sent to OSM at 505 Marquette Avenue NW, Suite 1200, <br />Albuquerque, New Mexico 87102. The revision may not proceed until OSM has been provided <br />copies. Copies should be sent certified mail. <br />Permit No.: C - ~ ~ - <br />Date: Q~ l O~ l g <br />- - - - - - - - - - - - - - - <br />Street: ~.~-~~~'-S1g----- <br />City: ~12L'2~L~~12.-1------- <br />State: ~ Q Zip Code: ~ / ~ ~ ~ - - - _ _ // (1 <br />Brief Description of Revision: f,~ ,~ ~ g ~ ~ - ~ ~ 1 g ~ L L <br />~-~~° ~Qs~L c -~ n .~ o <br />Public Notice Attached: Yes - No ~ (Required for PRs and TRsI <br />Bond Increase: Yes - No ~ Federal ~ Non-Federal - Mine <br />Proposed Change in: <br />Disturbed Area (+/-) - . Q Acres <br />- <br />~ <br />Permit Area (+l-) - ~~11 <br />/ <br />- S1 . QAcres <br />State Land (+/-) - _ Q . Q Acres <br />Affected Area (+/-) - - L! . (L Acres <br />Federal Land (+/-) - - Q. ~ Acres <br />Private Land (+l-) - - Q.Q Acres <br />m: \wel\s herslf o rme\rev. app <br />