REV92016

• Permit No: C1981038
• IBM Index Class Name: Revision
• Doc Date: 6/20/1994
• Doc Name: APPLICATION FORM FOR A REVISION TO A COAL MINING & RECLAMATION PERMIT
• Type & Sequence: MR93
• Media Type: D
• Archive: No

III IIIIIIIIIIIIIIII STATE OF COLORADO
DIVISION OF MINERALS AND GEOLOGY
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Department o RO
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1313 Sherman Si., Room 215

Denver, CO 80203 •

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Phone: [phone] a~
FAX: [phone]
Roy Romer
Governor
APPLICATION FORM FOR A REVISION Michael B. Long
TO A COAL MINING AND RECLAMATION PERMIT DivisionDirttror
This form must be completed and submitted with all requests for minor revisions, as defined in
Rule 1.04(731, technical revisions, as defined in Rule 1.04(361, and permit revisions, as defined
in Rule 1.04(90). All revisions are to address the requirements of Rule 2.08.4. Three (3)
copies of your revision, including maps, must be submitted in order for it to be complete.
All revisions are to be formatted so they can be inserted into the permit to replace the revised
sections, maps, tables and/or figures. Explain in the revision what section is being revised.
The revision date should be printed in the lower right corner of the revision pages. If
necessary, the Table of Contents should also be revised. When the final version of the revision
is approved, seven copies must be sent to OSM in Denver for federal mines; for non-federal
mines, one copy must be sent to OSM at 505 Marquette Avenue NW;cSuite 1200,
Albuquerque, New Mexico 87102. The revision may not proceed until OSMIIS~s''been provided
copies. Copies should be sent certified mail. ~fUN2
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Brief Description of Revision: _(~C !i ~ ~ ~ ~ - ~ ~ ~
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Public Notice Attached: Yes - No ~ /Required for PRs and TRs)
Bond Increase:.Yes - No ~ Federal ~ Non-Federal - Mine
Proposed Change in:
Disturbed Area (+/-) - - G. ~ Acres Affected Area (+/-) - - Q . ~ Acres
Permit Area (+/-) - - O . ~ Acres Federal Land (+/-1 - - Q. ~ Acres
State Land (+/-1 - - Q • ~ Acres Private Land l+/-1 - - ~. ~ Acres
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