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~` ~ COLORADO DIVISION OF MINERALS AND GEOLOGY <br />~•~' 1313 Sherman Street, Room 215, Denver, Colorado 80203, (303) 866-3567 <br />'one' <br />--- __ ........................._._ i~ffl..... <br />APPLICATION FORM FOR A REVISION AUG 0 91999 <br />TO A COAL MINING AND RECLAMATION PERMIT <br />Division of Minerals 8 Geology <br />This form must be completed and submitted with all requests for minor revisions, as defined in Rule <br />1.041731, 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 Rute 2.08.4. Three 131 copies of the revision, including <br />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 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 ell 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- ~_ - 0 v yDate: O g / 0 6 / 4 4 <br />Permittee: Cv/1rJS C~,.~n.:PG P-+r~er i!')~M1 <br />Street: l g o 1 C,o J .. ~, ~., .,~ L 0'1 <br />City: Cv-a: <br />State: GD Zip Code: ~ I ~ Z~ - <br />Brief Description of Revision: w~rl:a».s ~; K IIZ.lyer S~e.~-+b...K <br />5+,6~ 1: a ~+~... <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 (+/-) _ _ D G Acres <br />Permit Area (+/-) _ _ U 0 Acres <br />State Land (+/-) _ _ Q . ~ Acres <br />Affected Area (+/-) _ ~ . ~ Acres <br />Federal Land (+/-) _ - O . O Acres <br />Private Land (+/-) _ _ (~ . ~ Acres <br />m:lcoal\s h are\f o rm s\e 8 65 <br />y <br />