2008-04-22_PERMIT FILE - C1981017 (10)

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F~ ~. DEPARTMENT OF NATURAL RESOURCES David H. Getches. Executive Director MINED LAND RECLAMATION DI\ DAVlD C. SHELTON, Diroctor Richard D. Lamm Governor APPLICATION FORM FOR A REYISION 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), tech1~04(90)VisAllsrevisionsearentouaddress(the requPrements revisions, as defined in Rule 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 printnts~shouldlalso begreviseder of the revision pages. If necessary, the Table of Conte Date : - -/ _ -/ - _. Perini ttee : Nn ~ ~ _ ~ o N T l tiJ ~ t.~ i - - R F~ o u Q c ~==5 -L~c -- Street: ~o _, ~ c>>c ~ ~8------ • State: C 4 'Zip Code: 8 I 6 ? 3 - - - - - Permi t No.: C - ~ ~ - O.1... ~„ This box to be filled in by the Division: Type of Revision: - - (PR, TR, or MR) Revision Number _ _ (Sequential by Revision Type) . Revision Submittal~Date _/ / (Date Received by Division) Revision Completeness Date _/_/ ~ Revision Incompleteness Date -/ / Revision Adequacy Due Date -/ /_ Revision Adequacy Date -/ / Revision Decision Due Date / / Fee X0.00 Brief Description of Revision: ,~xP f1- N D - _. s ~ y' ~~- ~~ - ,~ ~ / C. ~ v S E ------ --- - Public Notice Attached - Yes / No (Required for PR's and TR's) Bond Increase: Yes ~ No Proposed Change in: - -• Disturbed Area (+/-) - Acres Affected Area (+/-) - ,_ -• - Acres _ -• • Permit Area (±/-) - Acres Federal Land (+/-) - ,_ - Acres - - State Land (+/-) - - - Acres Private Land (+/-) - - - Acres 6185E Lead Reclamation Specialist - - - 104 423 Centennial Building, 1313 Sherman Street Denver, Colorado 80203 Tel. (303) 866-3567 - .~, _ .: .~~~ gyn. ,, ,~,,.: ~ "" ~~~ .~. ,~.~ ~~ 1 ~. -.~ ~ e ~~ . , ..