Laserfiche WebLink
STATE OF COLORADO <br />•~~0~'~• Roy Romer, Governor <br />~s~c <br />DEPARTMENT OF NATURAL RESOURCES `~ ,~~, <br />MINED LAND RECLAMATION DIVISION r~',' ~-> •::'~ <br />FRED R. BANTA, Dlnttor ' '~~•-~ ' <br />APPLICATION FORM FOR A REVISION ~_-~"% ' <br />70 A COAL MINING AND RECLAMATION PEP,MIT ~-~~ ~'` <br />This form must be completed and submitted with all requests for minor revisions, as defined <br />in Rule 1,04(73), technical revisions as defined in Pule 1.04(36) and permit revisions, as <br />defined in Rule 1,04(90), All revisions are to address the requirements of Rule 2.08.4. <br />Three Copies of 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 replace the <br />revised Sections, maps, tables and/or figures. Explain in the revision what section is being <br />revised, The revision date should be printed in the lower right corner of the revision <br />pages. If necessary, the Table of Contents should also be revised. SJhen the final version <br />of the revision is approved, 7 copies must be sent tc OSJi in Denver for Federal mines and for <br />non-Federal mines 1 copy must be sent to OSM at 625 Silver Avenue, SW, Suite 31~, <br />Albuquerque, New Flexico 87102. The revision may not proceed until OSM has been provided <br />copies. Copies should be sent certified mail, <br />Date: - 8/ 3 0 / ~ ~ --.--h;-_ , ,.. <br />Permittee: o '" <br />SAP 0 3 1991 <br />treet: 1QZ 5O-{~1~ ~ 1~1~~1? <br />dined Lane' <br />--------------- ReclamatiorDivision <br />City: ~~ 5 ZO ~-------------- <br />State: ~p Zip Code: g L Q .~ L - - - - - <br />permit Ho.: c - ~ ~ - II L ? <br />J4ineName: ~L- ~-LL ~------------- <br />is Dox to oe rtllea to oy the utvtslon: <br />Type of Revision: _ _ (PR, TR, or MR) <br />Revision plumber: (Sequential by Revision Type) <br />Rev. Submittal Date: _ _/_ _/_ _ t0ate Received by Division) <br />Rev, Completeness Date: - -/- -/- - Rev, Incompleteness Date: - -/- -/- - <br />Rev. Adequacy Due Date: _ _/ _/_ _ Rev, Adequacy Date: _ /_ <br />- _/_ _ <br />Rev, Decision Due Date: /_ _ Lead Reclamation Specialist: <br />_ _/ _ _ <br />rte escrtp ton o evtston: S ~ ~ L [_ - ~ C ~ - - - - - <br />Public ploti <br />Attached - Yes ~o~ ~(~ <br />t~re~c ~or~R s and~P <br />s) <br />ce <br />Bond Increase: Yes g <br />, <br />Flo ~C_ ~1re eral FJon-Federal ~ !•±ine <br />~?roposed Change in: <br />: 'sturbed Area (+/-) p . 0 Acres Affected Area (+/-) ~ , Q Acres <br />_ <br />15'ermit Area (+/-) <br />- _ Q.~ Acres Federal Land (+/-) - - Q Acres <br />State Land (+/_} _ ~ Acres Private land (+/_) _ _ ~ Acres <br />6185E (Rev, 'IO/88) <br />215 Centennial Bui lding, 13 t 3 Sherman Street Denver, Colorado 80203-2273 T el. (3031 866-3567 <br /> <br /> <br />