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• <br />of coy <br />'``~ ,,~~ ~~a\ <br />~e I.;:-' 9~~' DEPARTMENT OF NATURAL RESOURCES <br />~ ~.,., ~ .,, ~ O*I Davitl H. Getcnes. Enecmive Director <br />'./ MINED LAND RECLAMATION DIVISION <br />/g76 DAVID C. SHEL70 N, Director <br />~. <br />Richartl D. Lamm <br />Governor <br />Application Form - -~ <br />~~" <br />Renewal of a Valid, Existing Permit ~ ~ ~~'~ ~ <br />to Conduct Coal Mining in Colorado ~ ~ ~ .J s y ~ <br />This form is an application for successive renewal of a valid, existing permit <br />to conduct surface or underground mining and reclamation activities or other <br />surface coal mining and reclamation operations in Colorado pursuant to CRS, <br />34-33-101, et seq. This application form is designed to revise and update the <br />application~orm currently included in your permit application. The right of <br />successive renewal applies only to lands and activity which were permitted <br />during the previous term. Extensions of the permit area and significant new <br />activity within the permit area are subject to the review procedures <br />applicable to new permit applications, in accordance with Rule 2.08. 5(1)(c) <br />and 2.08.4. Such changes will be handled by the Division as permit revisions, <br />and will be processed simultaneously with the application for renewal. Other <br />changes to the permit will be processed as technical revisions or minor <br />revisions in accordance with Rule 2.08.4. <br />For a renewal application to be deemed complete by the Division pursuant to <br />CRS, 34-33-109(7), an applicant must submit: (1) all information as specified <br />on this application form; and (2) a copy of the newspaper notice; (3) evidence <br />that a liability insurance policy will be provided for the proposed perjod of <br />renewal and (4) five reproducible copies of the permit renewal application <br />with original signatures. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly the appropriate information as listed below. <br />Supplemental sheets may be used as necessary. Such sheets must be attached to <br />the form and referenced or keyed to the numbers on the form. <br />1. Permittee <br />2. Name of Operation: <br />--------------------------- <br />3. Permit Number (same as current permit number): C- - <br />4. Type of Revision: R N Renewal Number: 0 <br />5. Application Submittal Date: / / <br />d23 Centennial Briilding. 1373 Sherman Street Denver, Colorado 80203 Tel. (303) 866-3567 <br />