Laserfiche WebLink
FROM <br />FAX N0. 17198464975 Tan. 05 2007 11:08RM P2 <br />a,,"Nn <br />~.... . <br />'a~~"a~C~'~I COLORADO DIVISION OF RECLAMATION, MINING AND SAFETY <br />`~-- ;.. <br />\_;,;;,i~ 1313 Sherman Street, Room 215, Denver, Colorado 80203, {3031 866-3567 <br />APPLICATION FORM FOR A REVISION <br />TO A COAL MINING AND RECLAMATION PERMIT <br />This foml 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(80). All revisions <br />are to address the requirements of Rule 2.OB_4. Three (3) copies of the revision, induding maps, must be <br />submitted in order for it m be complee~ <br />All revisions are to be formatted so they can be inserted into the permft to replace the revised sections, maps, <br />tables and/or fpures, with a revised table of contents, if necessary. The revision submittal date should be printed <br />in the lower right comer of each revision page. A cover Letter to the revision should explain the nature of the <br />revision and reference the spedfic permit secions being revised. <br />For federal mines, a Dopy of the revision application must be submitted to all agencies an the federal maTmg fist <br />(except OSM) a! the same time the application is submitted to the Division, and proof of distribution must be <br />submitled to the Division along with the appfiretion. Copies of rev~ion pages modified dudng the review process <br />must be distributed in the same manner, along with proof of distribution. Proof of dslnbulion must be submitted <br />prior to implementation of Ure revision. <br />Permit No.: C - ~ - Q~ Z^ Date: ~ ! bar I Zoo ~ <br />Permittee: ~icke,~cc~~s~ Q~ceSSrriJ~' l_G~ <br />Ne~rJ ~.lk ~1,~ ~-- <br />5treet: _ ? y / /5 C'r~ u u~ JQcQ ~- ~ <br />City: 1/i/llJl~ <br />state: Gn zip code: R J D ~ - <br />Brief Description of Revision: C~vtS~(~W! o~~- ~d.~ <br />~h~ <br />Public Notice Attached: Yes v No ,,_ (Required forPRs and TRs) <br />Bond Increase: Yes _ No ~/ Federal - Non-Federal c/ Mine <br />Proposed Change in: <br />Permit Area - <br />Disturbed (+1--) - - U . _„ Acres <br />Surface Ownership - <br />Private Land (+/-) - _ G7 . T Acres <br />Permit (+~) - - D • -Acres <br />Affected (+!-j _, - CJ . -Acres <br />Mineral Ownership - <br />Mineral Private (+/-) - - D . Acres <br />Federal Land (+i-) - - ~ . _ Acres <br />State Land (+h) - - j,~ . ~, Acres <br />Mineral State (+/-) ,., - ~ • - Armes <br />Mineral Federal (+/-) - - U . ~. Acres <br />