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STATE OF COLORADO <br />MINED LANO RECL,e,MA710N DIVISION <br />D~p~rtmsnt of Natural RtNOUreN <br />1313 $hifm~ll $t.. Room 21$ <br />D~nv~f. CO 9020 • ' <br />303 999.397 ~ <br />FAX: 347 932.9109 <br />Rv/ RartK, <br />OavNnor <br />Rr9i R. 9Nre. <br />APPLICATION EOld~i FOR A REUI3ICN awton ancxr <br />TD A OGAL bIIPTIIJG AND ItFX:LAI+Pl.TION PETQ~IIT <br />Ibis form must be p~7ahcA and submitted with all requests Por minor <br />revisions, as defined in Rile 1.04(73), technical revisions as defined in Azle <br />1.04(36) and permit revisions, ae defined iri Rule 1.04(90). All revisions are <br />to address the ~~~r~**x of Azle 2.08.4. Three (3) copies of your revision <br />including maps must be sUkmitted in order for it to ba o~~lete. <br />AL1 revisions are to be foratatted so they pan be ;r~+~*a into the permit to <br />replace the revised seCkiarls, maps, tables and/ar ligut~ss. btplaln in the <br />revision what section is being revised. 'Ihe revisitxr date should be ptrinted <br />in the lower ritght t>oi~uar of the revision pages. If *~~+~y, the Table of <br />Gontertt's shetald also be revised. Sdien the final vt3trsicm fo the revision is <br />approved, 7 cropies must be serif to 031 at 625 Silver Avenue, SW, 513itn 310, <br />n~ ~~~±p, New mexico 87102. the revisicm may not ~¢~oceed until 03~I has <br />been provided copies. Oopies should be sent certified mail. <br />Permit No.: Q- 8 Q- Q 5 6 <br />Date: Q.Q./ Q J ~ ~ <br />Pexmittee: ~ w ~F ~ ~ ~ M 3 ~ Q - C Q ~ ~ <br />~ o.SS~~ N~-------- <br />6treet: ~~~ 1 5-~ O U~~---- <br />C O~~j T Y-~~ A D-~ 7- <br />State: ~ 2 Zip Cade: ~ 0 ~ Si 1 - - - - - <br />MineNaine: F 0~~ E L-S~ E Ems- M I~j~--- <br />~ief Description of Revisicav S~ 2 ~ ~ _ i o ~, - , - - - , - <br />! ~~~ E~QS~ N-~ I N$-.-- <br />Public Notice Attached -Yes _ No X (Ragt.Lired far PR's and TR's) <br />Bond Increase: Yes g No _ Federal X Nom-Federal _ Mine <br />Proposed Change in: <br />Disturbed Area (+j-) - - ~j.A Acreii Affected Area (+/-) - - ~. A Ades <br />Permit Area (+/-) - _ N.A Acres Federal Iand (+/-) - ~ A AccPa <br />State Land (+/-) - N A Acres Private Lard (+/-) - N A A¢as <br />