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'' COLORADO DMSION OF MINERALS AND III IIIIIIIIIIIII III <br />••.r `.' 1313 Sherman Street, Room 215, Denver, Colo 999 <br />r~'t~t_rv~~-' ) <br />AUG 2 8 1998 <br />APPLICATION FORM FOR A RE <br />TO A COAL MINING AND RECLAMA' <br />8 <br />MI <br />This form must be completed and submitted with all requests for minor revisions, as defined in Rule <br />1.04(73), technical revisions, as defined in Rule 1.04(136), and permit revisions, as defined in Rule 1.041901. <br />All revisions are to address the requirements of Rule 2.08.4. Three (31 copies of the revision, including <br />maps, must be submitted in order for it to 6e complete. <br />All revisions are to be formatted so they can be inserted into the permit to replace the revised sections, <br />maps, tables and/or figures, with a revised table of contents, if necessary. The revision submittal date <br />should be printed in the lower right corner of each revision page. A cover letter to the revision should explain <br />the nature of the 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 <br />list (except OSM) at the same time the application is submitted to the Division, and proof of distribution must <br />be submitted to the Division along with the application. Copies of revision pages modified during the review <br />process must be distributed in the same manner, along with proof of distribution. Proof of distribution must <br />be submitted prior to implementation of the revision. <br />Permit No.: C - 8 I - D Z G Date: O ~ / ~~ / ~_ <br />Permittee: S 1 v r co ~ r n e r wf ~ off <br />Street: Q. 0, Pi v Y Z S' 1 3 0 4 <br />City: <br />State: <br />~G Kc woos <br />G D Zip Code: <br />Brief Description of Revision: <br />o tzg 9304 <br />R.+,....+,o„ o~ will ~ <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 />Disturbed Area (+/-) _ _, O . _ Acres Affected Area (+/-) ^ _ 0 . _ Acres <br />Permit Area (+/-) _ _ ~ , _ Acres Federal Land (+/-) _ ~ d . _ Acres <br />State Land (+(-1 _ _ 0 . _ Acres Private Land (+/-) _ _ O . _ Acres <br />m: \co al\sharelf orms188 65 <br />