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III IIIIIIIIIIIII III <br />999 <br />J U'1 L7 ' y4 <br />STATE OF COLORADO <br />DIVISION OF MINEItAlS AND GEOLOGY <br />fhpartmenl of rlalural Raowces <br />Ill ] SIl~vma~ S_ Room ]IS <br />o.m,a.. c~.ado eozm <br />crane: lion er,~-sstz <br />FN(: uosl atzalos APPLICATION FORM FOR A REVISION <br />TO A COAL MINING ANO RECLAMATION PERMIT <br />This form must be completed and submitted wide all requesU for minor revisions, as defined in <br />Rule 1.0403), tscfinical revisions, as defined in Rufa 1.04(361, and permit revisions, as defined <br />in Rule 1.041901. A11 revisions arc to address the requirements of Rule 2.08.4. Three 13) copies <br />of the revision, including maps, must be subm'rmd in order for it to be rnmplete. <br />~I <br />~~~~~~ <br />DEPARIMFtTf OF <br />NATURAI <br />RESOURCE <br />Ro, same. <br />Go.ernar <br />lem., s Load¢ad <br />t.etw.e D.rocm, <br />Michael a. Lon{ <br />O~•~tim Oieclar <br />All revisions am to be formatted so they an be inserted into the permit to replace the revised <br />sections, maps, tables and/or fquros, with a revised Ubls of wrnants, 'If necessary. The revision <br />submittal date should be pruned in the IOwer right comer of each revision papa. A cover letter to the <br />revision should elq~lain the nature of the revision and reference the specific permit sections being revised. <br />fvr federal mines, a copy Of the revision appicatioll must be submitted t0 all apeneias on the federal mailing <br />list st the sartra tirtw tM appiicaoion is submitted to the Division, and proof of distribution must be submitted <br />to the Division aiorlg whh the appl(cation. Copies of revision Pages modiRad during the review Process must <br />be distributed in the same manner, along with proof of diaMbvdon. proof of dievibudon must De submitted <br />prior to irrlp{erllarrLtion of the revision. Far non-fadaal mbtas, a ooPY o} the appGeation for which tM <br />Division has issued a proposed approval daeiabn must be subnlitxd to the OSM Albugwrgw Fnld Office <br />1AF01, and proof of submittal to AFO moat be submimed to the Division Prior m impNnwntation of the <br />revision. <br />. <br />Permit No.: C --'~8 ~ - ~ ~ 3 Date: _ b / - ~1 ~ s <br />Permittee: 5 aS%ti ~N S_v d,2n_P~ - - - - _ <br />street: .1 ~ 3 ov _ f{~ c~k ~.r~ -(~ - - - <br />City: ~~S / ~ ti - - - - - - - - <br />State: ~~ Zip Coda: g ~ ~ 92- _ - - - ,f <br />Brief Description of Revision: ~ ~~~c~ v!v ~ N S vii S . CX C~/C ~ - <br />F79'271aM1 DIViI1IPERFlLS8GE0LOGY P.2~5 <br />/~fo/V ~ ,~ ,~v A t rUo2 (~'I ~f'~i~ti5 <br />~/~i ~ LIiJQi1J Us.cl ~/ f~'- - - - - - <br />PubPle Notice Attached: Yes No - /Required for PRs and TRsI <br />Bond Increase: Yes - No / Federal v~lon-Federal - Minc <br />Proposed Change in: <br />Disturbed Ares (+/-) - - _ -Acres <br />Permit Area (+/-) - - - -Acres <br />Slits Land (+/-) - - _. _ Apes <br />Affected Area (+/-) - - - -Acres <br />Federal Land (+/-) _ - - -Acres <br />Private Land (+/-1 - - - . -Acres <br />m:bodbrlrNlormalaae6 <br />