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iii iiniiiiiiiu ii <br />STATE OF COLvx~ii~v <br />MINED LAND RECLAMATION DIVISION <br />Department of Narural Resources <br />1313 Sherman SI.. Room 215 <br />Denver, CO 80203 <br />303 666-3567 <br />Fa x: 303 832-8106 <br />a~~~'P>~ <br />pF' Cpl <br />He// 1 <br />..~ <br />a.:~y'+ <br />~E]6 ~ <br />Roy Ramer. <br />Governor <br />FreE R. Banta. <br />APPLICATION FORM FOR A REVISION o^^ra^aAe^-ror <br />70 A COAL MINING AND RECLAMATION PERMIT <br />This form must 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 sec tians, 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 must 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 - ~ ) - d ~ <br />Date: r ?/ j,Za/ 4' ~- <br />Permittee: C- rr- ~ I <br />Street: 1~j CoJn~~l,~-~~ - - ,_, _, - <br />.-.-.-----.-------- <br />City: DLO ~~C~ - --------- <br />State: C O Zip Code: ~ ( 2 Z ~ _c - - - <br />Mine Name: ~~U =~ d=~E_l-~-~ ~ ------- <br />Brief Description of Revision: 1 ~ ~ ~ Lr~:~ ~_ _ _ _ _ _ <br />Public Notice Attached - Yes ~ No _ (Required for PR's and TR's) <br />Bond Increase: Yes No ~ Federal Non-Federal Mine <br />Proposed Change in: <br />Disturbed Area (+/-) - - 1, 3 Acres <br />Permit Area (+/-) - - ( ,3 Acres <br />State Land (+/-) Acres <br />Affected Area (+/-) - - ~.~ Acres <br />Federal Land (+/-) - - - Acres <br />Private Land (+/-) - _ 1 •3 Acres <br />6185E (10/90) <br />