Laserfiche WebLink
' STATE OF COLORADO <br />MINED LAND RECLAMATION DIVISION oF.~a~ <br />Department of Natural Resources a``~'~~ <br />°%18 <br />1313 Sherman St.. Room 275 <br />Denver, CO 80203 ~ n` F , rt~ ~ <br />303 8663567 ~ ~+ + <br />FA%. 303 8328106 ra'l6 <br />Roy Romer. <br />Governor <br />Fred R. Banta. <br />APPLICATION FORM FOR A REVISION oivislon 0iregor <br />TO A COAL MINING ANO RECLAMATION PERMIT <br />This form nest 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. Three (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 nest be sent to OSM in Denver for Federal mines and for <br />non-Federal mines 1 copy must 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 - ~ ~ - O / S <br />Date: D l / OZ / ,g,~ ~Lm~v~Q~ ~~ <br />Permi ttee: $- ~ E~ L r ~e~, ,_, ~ N ,L E L,D <br />Street: 1, ~ ,~ 3 ~- LV - l~~dlr~~` Mined Land <br />~~ ~ j~ ~ S S ~~ Y - - - - -Ra^.lamation D^-'-` <br />city: ~,~~- ~B-.s_.------------_. <br />State: rjC Zip Code: Z ~ oL ~ ~ - - - - - <br />Mine Name: ~,Q~~L~-~-~1 d1 ~~--__---- <br />Brief Description of Revision: ~ ~ ~0 ~~ ~~ ~- ~dC ~2 G ~ A/- <br />~L ~ ~ 13~ ~A1C1,AA~L ~P[~~~' - - <br />~-pQ~------------ <br />Public Notice Attached - Yes ~ No - (Required for PR's and TR's) <br />Bond Increase: Yes No ~ Federal Non-Federal 'J Mine <br />Proposed Change 1n: <br />Disturbed Area (+/-) _ _ _.p Acres Affected Area (+/-) _ _ Acres <br />- <br />Permit Area (+/-) - - -,~ Acres Federal Land (+/-) - <br />Acres <br />State Land (+/-) - - ~ Acres Private Land (+/-) - - Acres <br />6185E (10/90) <br />