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~: <br />- of Coto <br />'t4' 'p9 <br />Fe $ DEPARTMENT OF NATURAL RESOURCES <br />**~ Davtd H. Getchae. Executive Director <br />.,876. MINED LAND RECLAMATION DI\ <br />DAVID C. SHELTON, Director <br />Ricnard D. Lamm <br />Governor 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 <br />defined in Rule 1.04(73), technical revisions as defined in Rule 1.04(36) and permit <br />revisions, as defined in Rule 1.04(90). All revisions are to address the requirements <br />of Rule 2.08.4. <br />All revisions are to be formatted so they can be inserted into the permit to replace the <br />revised sections, maps, tables and/or figures. Explain in the revision what section is <br />being revised. The revision date should be printed in the lower right corner of the <br />revision pages. If necessary, the Table of Contents should also be revised. <br />Date: ~ L/ ~~ <br />Permittee: ~~L~C.~-~IC~~--- <br />~.1ZL2 ~1L~ ~.ZLQ ~---- <br />Street: 1Q~- S-L~~~ZS2L/-SL`s --~r--~ <br />city: ~~~~d~_2 o rs~~LL/~E~---~1-0V 61981 <br />State: C ~ Zip Code: g Q ~~~ - - - - AAIA(~J LANq <br />Permit No.: C - 8 L - O~2 ~ ~tECLAM;~ i If}hj ~JIbI:;;10N <br />This box to be filled in by the Division: <br />Type of Revision: _ _ (PR, TR, or MR) <br />Revision Number _ _ (Sequential by Revision Type) <br />Revision Submittal Date _/_/ (Date Received by Division) <br />Revision Completeness Date -/ /_ Revision Incompleteness Date -/-/ <br />Revision Adequacy Due Date _/_/_ Revision Adequacy Date _/_/_ <br />Revision Decision Due Date / / Fee 50.00 <br />Brief Description of Revision: ~E/fI,L'o.Gific~i~EC ~~.1/,91~~/ <br />-~~ C~-~ ~z-------- <br />Public Notice Attached - Yes No -'(Required for PR's and TR's) <br />Bond Increase: Yes _ No _ <br />Proposed Change in: <br />Disturbed Area (+/-) _ _ _ _ Acres Affected Area (+/-) _ _ _ _ Acres <br />Permit Area (+/-) _ _ _ _ Acres Federal Land (+/-) _ _ _ Acres <br />State Land (+/-) _ _ _ Acr <br />e <br />s Private Land (+/-) _ _ _ Acres <br />Lead Reclamation Specialist L l <br />/ <br />- W 6185E <br />423 Centennial Building, 1313 Sherman Street Denver, Colorado 80203 Tel. (303) 866-3567 <br />