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~~ iiii~iiiniu m . - <br />999 . <br />.~. <br />. ~, . <br />COLORADO DIVISION OF 1ViINERALS AND GEOLOGY <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 />RECEIVEQ <br />This form must be completed and submitted with all requests for minor ~'~i `o3ts, ~~~efined in Rule <br />1.04173), technical revisions, as defined in Rule 1.041136), and permit revisions, as defined in Rule 1.04190). <br />All revisions are to address the requirements of Rule 2.08.4. Three 131~~1~$IfiAnB1>ds~Gr~d9@y 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 minas, 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 - ~1 [. - D $ Date: D~ l Z ~ 1 9 8 <br />Permittee: )_ o r ~„~ c ~ iv C~ ti l ~ r.., , w., L L c <br />Street: yLV3 S.+~t-~, yls~/-r Stra,.+ <br />5..,%te_ 1270 <br />City: ~ ~,,,,~ ~r <br />State: G.~ Zip Code: g'~ L 3 7 <br />Brief Description of Revision: 4 ~ ,,,.. t i, ~ e L i.- ~ ~. ~ <br />Public Notice Attached: Yes X <br />Bond Increase: Yes _ No <br />Proposed Change in: <br />Disturbed Area (+!-) _ _ ~ <br />Permit Area (+/-) _ _ D <br />State Land (+/-) _ _ Q <br />No _ /Required for PRs and TRs) <br />Federal _ Non-Federal ,~ Mine <br />_ Acres Affected Area (+/-) _ ~ Q <br />_ Acres Federal Land (+/-) _ _ ~ <br />_ Acres Private Land (+/-) _ _ <br />Acres <br />_ Acres <br />Acres <br />m:lcoal\sh are\fo rm s\8865 <br />