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r~i l~rri~«iiiii iii ~~ <br />OF' CO< <br />~~`., ~/ <br />~~~ ~ o DEPARTMENT OF NATURAL RESOURCES ~f a <br />* ~~~ + Davitl H. Getches, Executive Director <br />` " MINED LAND RECLAMATION DIVISION <br />* f g76 * DAVID C. SHELTON, Director <br />Richard D. Lamm <br />Governor APPLICATION FORM FOR A REVISION <br />TO A COAL MINING AND RECLAMATION PERMIT - i ` <br />This form must be completed and submitted with all requests for minor revisions, as <br />defined in Rule 1.04(73), technical revisions as defined in Rule 1.04(36) and permit <br />revisions, as defined in Rule 1.04(90). All revisions are to address the requirements <br />of Rule 2.08.4. <br />All revisions are to be formatted so they can be inserted into the permit to replace the <br />revised sections, maps, tables and/or figures. Explain in the revision what section is <br />being revised. The revision date should be printed in the lower right corner of the <br />revision pages. If necessary, the Table of Contents should also be revised. <br />Date: _ _/ _ _/ _ <br />Perini ttee : W y p~ i ,+2 ~- ~Et_. - Co s~„o~~7. <br />Street: 1 ~ a yam' - W~ ~- ~¢~r=/ ~/~-~-~. <br />City: L,i9-K~=+oo d ------------- <br />State: L, o Zip Code: ~ o a 7 y - ~~ / ', <br />Permit No.: C - ~/ - OL ~ <br />This box to be filled in by the Division: <br />Type of Revision: ~ IZ (PR, TR, or MR) <br />Revision Number 1 ~ (Sequential by Revision Type) <br />Revision Submittal Date ~/~/~6(Date Received by Division) <br />Revision Completeness Date ~/~/~ Revision Incompleteness Date -/ / <br />Revision Adequacy Due Date _/_/_ Revision Adequacy Date _/_/_ <br />Revision Decision Due Date Q /FC Fee 50.00 <br />Brief Description of Revision: ~FE,Q- /l~~jC -Gy~BwC-~' - <br /> <br />Public Notice <br />Attached - - - <br />Yes _ - - - - - - - - - - - - - - - <br />No ~L.(Required for PR's and TR's) <br />Bond Increase: Yes _ No <br />Proposed Change in: <br />Disturbed Area (+/-) _ _ _ Acres <br />- Affected Area (+/-) _ _ _ _ Acres <br />Permit Area (+/-) _ _ _ _ Acres Federal Land (+/-) _ _ _ Acres <br />State Land (+/-) Acres Private Land (+/-) Acres <br />Lead Reclamation Specialist 6185E <br />423 Centennial Building, 1313 Sherman Street Denver, Colorado 80203 Tel. (303) 866-3567 <br />