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III IIIIIIIIIIIIIIII . -- - <br />999 ~ COLORADO DMSION OF MINERALS AND GEOLOGY <br />~•.r~,' 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 all requests for minor revisions, as defined in Rule <br />1.041731, technical revisions, as defined in Rule 1.04(1361, and permit revisions, as defined in Rule 1.04(901. <br />All revisions are to address the requirements of Rule 2.08.4. Three (3) 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 and/or 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 lexcept OSMI 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 - ~ - D $ y Date: I Z / Z .B / o G% <br />Permittee: L. e: v. c. I 4.. L L c <br />Street: _ yc421 1~,- a,~ Stc t: a•, t ow,.~ <br />City: ~ z x ... ,: +,~ ., <br />State: ~ y Zip Code: 4051!, - <br />Brief Description of Revision: M=.~ Ta-.~„, IZ z~. v ~,/ <br />Public Notice Attached: Yes _ No ~ (Required for PRs and TRsI <br />Bond Increase: Yes _ No ~ Federal _ Non-Federal ~ Mine <br />Proposed Change in: <br />Disturbed Area (+/-) _ _ (~ . _ Acres Affected Area (+/-) _ _ G _ gcres <br />Permit Area (+/-) _ _ 0 . _ Acres Federal Land (+ /-) _ _ C . _ Acres <br />State Land (+/-) _ _ ~, . _ Acres Private Land (+/-) _ _ L) . _ Acres <br />m: \co al\sh are\f o rm s 1886 5 <br />