REV102556

• Permit No: C1980007
• IBM Index Class Name: Revision
• Doc Date: 7/23/1986
• Doc Name: APPLICATION FORM FOR A REVISION TO A COAL MINING & RECLAMATION PERMIT
• Type & Sequence: TR52
• Media Type: D
• Archive: No

of corn
R~ 'p9
i"~- O
.rrn ~c~/,~ ,'
~s~e'
Richartl D. Lamm
Governor
DEPARTMENT OF NATURAL RESOURCES
Davrd H. Getches, Executive Director
MINED LAND RECLAMATION DIVISION
DAVID C. SHELTON, Director
APPLICATION FORM FOR A REVISION
TO A COAL MINING AND RECLAMATION PERMIT
This form must be completed and submitted with all requests for minor revisions, as
defined in Rule 1.04(73), technical revisions as defined in Rule 1.04(36) and permit
revisions, as defined in Rule 1,04(90), All revisions are to address the requirements
of Rule 2.08.4.
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.
Date: OZ/~3/g4
Permittee: (mil EsS~1fLCOl~~ ~D/7Pf1N ~ - -
/L1t. 6uan iso ~_ No . 2 r~l~v, e - -
Street: ~D-~ OZ( - ~'S I -----
City: SOr1~Q~,~=-----------
State: C U Zip Code: g L ~ 3 '~ - - - - -
Permit No.: C- Q U- C7 O Z
This box to be filled in by the Division:
Type of Revision: IH ~ (PR, TR, or MR)
Revision Number 5 2- (Sequential by Revision Type)
Revision Submittal Date G / ~ /~ (Date Received by Division)
Revision Completeness Date (o /~/~/~ Revision Incompleteness Date /_/
Revision Adequacy Due Date Q / I / Q~/ Revision Adequacy Date (~/L/Q ~i
Revision Decision Due_Date 4 /'} /$~ Fee 50.00
Brief Description of Revision: all~nhta~~c. Qtwq ~C~1h _~eyi~z_ f"r-_
~eerl=No. 1 ~~a! - ~~.5 - - - - -
Public Notice Attached - Yes X No (Required for PR's and TR's)
Bond Increase: Yes _ No ~C
Proposed Change in:
Disturbed Area (+/-) _ _ _ _ Acres Affected Are a (+/-) _ _ _ _ Acres
Permit Area (+/-) _ _ _ _ Acres Federal Land (+/-) _ _ _ Acres
State Land (+/_) Acres Private Land (+/-) Acres
Lead Reclamation Specialist Z~.$- 6185E
423 Centennial Building, 1313 Sherman Street Denver, Colorado 80203 Tel. [phone]
ui i ii iii iniu iii
999