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STATE OF COLORADO <br />MINED LAND RECLAMATION DIVISION <br />Department of Natural Resources ,~~ ~F~,C~~ <br />T <br />~~~' <br />1313 Sherman St.. Room 215 ~ ~ ~$ <br />Denver. CO 60203 '+~~. <br />303 866-3567 <br />Fax: 303 832-8106 'rage' <br />Rq Rpnx, <br />Goumnu <br />FreC R. Banes. <br />APPLICATION FORM FOR A REVISION oivislon 0inr_tor <br />TO A COAL MINING AND RECLAMATION PERMIT <br />This form mist 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 sections, maps, tables and/or figures. Expiairt 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 - ~ ~ - ~1 <br />Date: ,~ ~/ L.~/~ ~ <br />Street: si..1.,:~'. - ~ - ~. ~ ,~ ~ ~, .,(J- - _. <br />OCR 1 ° 1992 <br />State: ,~4 ~ Zip/ Codenn~ 7 Z l '~ - - - - - !`nT`lE~~^~: -'~;... _ <br />Mine Name: 1L ~ ~ ,c_. - Ll ~ _2,'~ - ~ Z- - - - - <br />~ ;..r- - . <br />Brief Description of Revision: L ~ ~ ~ _ ~ - ~ ~ ~ - ~ - - <br />Public Notice Attached -Yes No (Required for PR's and TR's) <br />Bond Increase: Yes No ~ Federal ~ Non-Federal Mine <br />Y <br />Proposed Change in: <br />Disturbed Area (+/-) ~~_.1"~.- Acres <br />Permit Area (+/-} _ _ _ Acres <br />State Land (+/-) i Acres <br />Affected Area (+/_) - - - - gcres <br />Federal Land (+/_) Acres <br />Private land (+/_) <br />Acres <br />6185E (10/90) <br />