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DEPARTMENT OF NATURAL RESOURCES <br />David H. Gelcnef. Erecullve Dtredor <br />MINED LAND RECLAMATION DIVISION <br />DAVID C. SHElTO N, Dlre clor <br />P~<h s.d D. Lamm <br />Gm<mor <br />APPLICATION FORM FOR A REVISION <br />TO A COAL M[NIN6 ANO RECLAtgAT10N PERI4IT <br />This farm 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(901. 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 1s <br />being revised. The revision date should be printed in the lo~~er right corner of the <br />revision pages. !F necessary, the Table of Contents should also be revised. <br />Date: t 1 / 0 9/ 9 0 <br />Permittee: p ~{~.g-.0 D Y _ C 0 A L___ -"" '~ "~ '-` <br />~~.1i~..9s1_Y-------- - .. ,. <br />Street: ~~ 0 0_ S O U T H_ Y A L E <br />riou 13 )~~a <br />City: F L A G S T A F F _______ ~':in°GL2nd <br />~e: A Z Zip Code: 8 6 0 0 1 - _ _ _ Ffrciams:ion Division <br />I Permit iJo.: C- 8 2 - 0 5 7 <br />This box to be filled in by the Division: <br />Type of Revision: __ (PR, TR, or FiR) <br />Revision Number _ _ (Sequential by P,evision Type) <br />Revision Submittal Date _!_/+ (Date Received by Division) <br />Pevision Completeness Date _/ /_ Revision Incompleteness Date `/ / <br />Revision Adequacy Due Date _/ / Revision Adequacy Date _/ / <br />Revision Decision Due Date / / Fee E0,00 <br />Brief Description of Revision; M I N I N G_ _ A N D _ R E C_ <br />P L A N R E Y I S I O N <br />----------------- <br />Public 1Jotice Attached -.Yes X ilo (Required for PR's and TR's) <br />Bond increase: Yes ilo <br />Proposed Change tn: <br />Disturbed Area (©/-) 3 3 6 . 3 Acres Affected Area (C+`~'-) 3 3 6 .3 Acres <br />~Jt Area ~/-) 110 2 1 Acres Federal Land ~-) _3 0 .2 Acres <br />_e Land (~/-) _ _ 0 Acres Private Land ~-) ~ 0~ L, g Acres <br />Reclamation Specialist 6185f <br />23 Centennial fluilding, 131D Sherman Sllel•.i C~envel, Colorado 6020) Tel. i~p~l D66 ~SG7 <br />