Laserfiche WebLink
A OF III IIIIIIIII IIII III <br />COLOKADO DIVISION OF MINE AND GEO_ _ _ 999 <br />•,,~' 1313 Sherman Street, Room 215, Denver, Colorado 80203, (303) 866-3567 <br />APPLICATION FORM FOR A REVISION <br />TO A COAL MINING AND RECLAMATION PERMIT <br />This form must be completed and submitted with atl requests for minor revisions, as defined in Rule <br />1.04(731, technical revisions, as defined in Rule 1.0411361, and permit revisions, as defined in Rule 1.041901. <br />All revisions are to address the requirements of Rule 2.08.4. Three 13) copies of the revision, including <br />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 revised sections, <br />maps, tables andlor figures, with a revised table of contents, if necessary. The revision submittal date <br />should be printed in the lower right corner of each revision page. A cover letter to the revision should explain <br />the nature of the 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 <br />list (except OSM) at the same time the application is submitted to the Division, and proof of distribution must <br />be submitted to the Division along with the application. Copies of revision pages modified during the review <br />process must be distributed in the same manner, along with proof of distribution. Proof of distribution must <br />be submitted prior to implementation of the revision. <br />Permit No.: C - QL~ - CJ 2 Z Date: ~_ / ~~ / ,9~ <br />/ I I <br />Permittee: (~,r !Or ~, ~p}~ ~ ~;,,pv~.la INC. <br />Street: ~. O ` Jo.i S' "' ,~ <br />City: sue, r.., .;~_ s ~ ~- <br />State: L'[2_ Zip Code: ~~~/ z ~ - <br />Brief Description of Revision: <br />Public Notice Attached: Yes _ No ~ /Required for PRs and TRs/ <br />Bond Increase: Yes~K No _ Federal ~[ Non-Federal _ Mine <br />Proposed Change in: <br />Disturbed Are (+/-) _ _ ~ . Acres Affected Area i+/-) _ _ Acres <br />Permit Area +/-) _ _ _ _ Acres Federal Land (+/-) _ _ _ _ Acres <br />State Land (+!-) _ _ _ ,Acres <br />Private Land 1+/-) _ _ _ _ Acres <br />m:1co aI\s hare\fo rm s\8665 <br />