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pF' <br />ti ti.~: <br />w~i <br />~~LORADO DIVISION OF MINERALS AND GEOLOGY <br />RE• 1313 Sherman Streef, Room 2i5, Denver, Colorado 80203, (303) 866-3567 <br />p,~G ~ ~ FtECEI`~ ~~ <br />~neca\s and Ge°\o9V <br />n°\N\ APPLICATION FORM FOR A REVISION n <br />u\"`s'0 TO A COAL MINING AND RECLAMATION PERMIT ""~ 1 5 2~^' <br />e°I°9Y <br />This fomt must be completed and submitted with all requests for minor revisions, as defined- ift, Ruda~ell'f4Y73~ <br />technical revisions, as defined in Rule 1.04(136), and permit revisions, as defined in Rule 1.04{90). All revisions <br />are to address the requirements of Rule 2.08.4. Three (3) copies of the revision, including maps, must be <br />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 printed <br />in the lower right comer of each revision page. A cover letter to the revision should explain the nature of the <br />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 list <br />(except OSM) at the same time the application is submitted to the Division, and proof of distribution must be <br />submitted to the Division along with the application. Copies of revision pages modified during the review process <br />must be distributed in the same manner, along with proof of distribution. Proof of distribution must be submitted <br />prior to implementation of the revision. <br />Permit No.: C - s~ - o'tN Date: $ I ~_ I ~. <br />Permittee: La.,.oMa.Rx REU.MnwTre~l~ Lv~. <br />Street: 490t 5. lil~uv.~lstsMEte,E <br />city: L, 7r 6G.TeN <br />State: ~_ Zip Code: $CIZC <br />Brief Description of Revision: SEcr+oN 'L• CS,S I~osT-M~NrNb <br />LA~vD V~~ t7~G~s 'rv+<E QVeNSET <br />Vrr.D~^-9. As A ~gMA1NWts 5TR\xNRE~ <br />,awo iNC,cuara -,~,sn+NUr~r Pt~we P~a,a.>wf~.Y <br />Public Notice Attached: Yes No (Required for PRs and TRs) <br />Bond Increase: Yes _ Nom Federal _ Non-Federal K Mine <br />Proposed Change in: <br />Permit Area - <br />Disturbed (+/.) _ _ _ _ Acres <br />Permit (+/-) _ _ _ _ Acres <br />Affected (+/-) _ _ _ _ Acres <br />Mineral Ownership - <br />Mineral Private (+/-) _ _ _ -Acres <br />Mineral Federal (+/-) _ _ _ . _ Acres <br />Surface Ownership - <br />Private Land (+/-) _ _ _ . _ Acres <br />Federal Land (+/-) _ _ _ . _ Acres <br />State Land (+/-) _ _ _ _ Acres <br />Mineral State (+/-) _ _ _ . _ Acres <br />