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COLO~O DMSION OF MINERAL~AND G~ II I I II I II I II IIII III <br />'•n~i.• 1313 Sherman Street, Room 215, Denver, Colorado 80203, (303) 866-3567 <br />APPLICATION FORM FOR A REVISION <br />TO A COAL MINING AND RECLAMATION PERMIT <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 1.0411361, and permit revisions, as defined in Rule 1.041901. <br />All revisions are to address the requirements of Rule 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 all agencies on the federal mailing <br />list (except OSMI 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- .K ~ - O Z 3 Date: l Z / L ~Y l 0 0 <br />Permittee: ~ 4 ~ S z ; +„I r. ~ t v ; r. 5 L h c.. <br />Street: ~. U.. ~, ~, v ; Z <br />Cilt)r; Dpszr'~ C ,nt L~ <br />State: G A Zip Code: 9 2 2 3 9 - <br />Brief Description of Revision: -~l: c~ T.z-,~ m If..e,.i'- t,/ <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 (+ /-) _ _ 0 . _ Acres Affected Area (+ /-) _ _ y . _ Acres <br />Permit Area (+/-) _ _ C . _ Acres Federal Land (+/-) _ _ ~ . _ Acres <br />State Land (+/-) _ _ ~ . _ Acres Private Land (+/-) _ _ ~ . _ Acres <br />m:lcoallshare\f orms\8865 <br />