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of ~ <br />h, ~~ <br />~ /~ <br />~svs <br />COLORADO DIVISION OF MINERALS AND GEOLOGY <br />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 1.04(73), <br />technical revisions, as defined in Rule 1.04(136), and permit revisions, as defined in Rule 1.04(90). All <br />revisions are to address the requirements of Rule 2.08.4. Three (3) copies of the revision, including maps, <br />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, maps, <br />tables and/or figures, with a revised table of contents, if necessary. The revision submittal date should be <br />printed in the lower right corner of each revision page. A cover letter to the revision should explain the nature <br />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 - ~ - ~7_.Q Date: ~O / // / ~_ <br />Permittee: ~ P--f~nl D ~~Gt ~ ~~ V ~O~ L <br />Street: <br />City: L-C~ G'(/l ~-1 ~ L ~ J <br />State: C~ Zip Code: lS Zy- - 1SO`7O <br />Brief Description of Revision: ~Sb~'id~l S~ ~O ~ I <br />Public Notice Attached: Yes ~ No _ (Required for PRs and TRs1 <br />Bond Increase: Yes No X Federal Non-Federal Mine <br />Proposed Change in: <br />Disturbed Area (+/-) _ _ ~ . Acres Affected Area (+/-) _ <br />` _~ <br />Acres Federal Land (+/-) _ <br />Permit Area (+/-) _ _ ~_ . _ _ ~ . <br />State Land (+/-) _ _ ~ . -Acres Private Land (+/-) _ _ ~. <br />Acres <br />_ Acres <br />Acres <br />