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STATE OF COLOR-ADG <br />MINED LAND RECLANIATION DIVISION <br />Department of Natural Resources <br />7373 Sherman St., Room 215 <br />Denver. CO 80203 <br />303 866-3567 <br />Fn X: 303 832-8706 <br />OF ~~/-0 <br />~:s,-~8 <br />;* . <br />•l <br />~~: <br />~/Bib <br />Roy Ramer. <br />Gwemor <br />' Fretl R. Barra. <br />APPLICATION FORM FOR A REVISION oivision Orte~_.or <br />TO A COAL MINING AND RECLAMATION PERM I7 <br />This form mist be completed and submitted with all requests for minor <br />revisions, as defined in Rule 1.04(73), technical revisions as defined in <br />Rule 1.04(36) and permit revisions, as defined in Rule 1.04(90). All <br />revisions are to address the requirements of Rule 2.08.4. firee (3} copies of <br />your revision including 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 <br />replace the revised sections, maps, tables and/or figures. Explain in the <br />revision what section is being revised. The revision date should be printed <br />in the lower right corner of the revision pages. If necessary, the Table of <br />Contents should also be revised. When the final version of the revision is <br />approved, 7 copies must be sent to OSM in Denver for Federal mines and for <br />non-Federal mines 1 copy mist be sent to OSM at 625 Silver Avenue, SW, Suite <br />310, Albuquerque, New Mexico 87102. The revision may not proceed until OSM <br />has been provided copies. Copies should be sent certified mail. <br />Permit No.: C - ~ L - ~ 1 ~ RECEIVED <br />Date: ~, S / L 3 / ~ 1 <br />Permittee: W o m ~ L, _ F ~ e L _, ~ o ~-AY ~ 1 1991 <br />-~----~-------- Mined Land <br />Street: 1 Q z S d - ~l i, ~ ~ ,(~, g ~ - / 2,~eclamation Division <br />- - - - - - - - - - - - - - - <br />City: I,~ ~5~~~' -------------- <br />state: C O zip Code: 8 L. ~ 3 L- 12 0 3 1. <br />Mine flame: ~11g1el-~1LE-lLI=~ e._-.----- <br />Brief Description of Revision: A d _( - L i } ~ y- ~ e - ~ 6 <br />~i1.~.? ~ -~ u ~ r LL- o ~ <br />Public Notice Attached -Yes No / (Required for PR's and TR's) <br />Band Increase: Yes No ~ FederaT Non-Federal Mine <br />Proposed Change in: <br />Disturbed Area (+/_) - - Q ,~ Acres <br />Permit Area (+/-) Acres <br />Affected Area (+/-) - - ~,~ Acres <br />Federal Land (+/-) Acres <br />State Land (+/-) Acres <br />Private Land (+/-) <br />Acres <br /> <br />