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r _q <br />~`~"' , ~$ DEPARTMENT OF NATURAL RESOURCES <br />,r,o ~ * David M Getches. Eaecwwe Ouedor <br />•'F~" MINED LAND RECLAMATION DID <br />/g~6 ~ DAVID c. SHELTON, Director <br />Richard O. Lamm <br />GOvet^~r APPLICATION FORM FOR A REVISION <br />TO A COAL MINING AND RECLANJ4TION PERMIT <br />This form must be completed and submitted with all requests for minor revisions, as <br />defined in Rsldefined7in~Ruleh1i04(90)VisAllsrevisionsearentouaddress(the requirements <br />revisions, a <br />of Rule 2.08.4. <br />Ali 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: O ~/ a ~/ ~ 8 <br />Perini ttee : 1LA ~ ~ ._ ,~. ~ ~ L J- ~? -~- ~ S - - <br />~,~. S O u ~Z C t S ~~L~ ~-- <br />Street: ~ O• $ O .1~.-~Q- U ------ <br />ate: C O Zip Code• ~ L ~ a 3 - - - - ._ <br />- r <br />Permit No.: C- 8 1 - O ~ 'Z . <br />This box to be filled in by the Division: <br />Type of Revision: - - CPR, TR, or MR) <br />Revision Number (Sequential by Revision Type) <br />Revision _ _ <br />Submittal Date / / (Date Received by Division) <br />P.evision Completeness Date / / - Revision Incompleteness Date /_/ <br />Revision Adequacy Due Date -/ / Revision Adequacy Date -/ / <br />Revision Decision Due Date / / Fee X0.00 <br />Brief Description of Revision.: ,,,jL ~1 ~ ~ ~ ~.L ~ ~" L - L L ~ ~ ~ ~ <br />Public Notice Attached - Yes ~ No (P.equired for PR's and TR's). <br />Bond Increase: Yes No ~ <br />Proposed Change in: <br />isturbed Area (+/-) - - D . O Acres <br />~ermi t Area (+/-) _ ~ 0 .0 Acres <br />State land (+/-) - - ~ Acres <br />lead Recl ac~ation Specialist <br />423 Centennial 8uitding, 1313 Sherman <br />Affected Area <br />Federal Land <br />Private Land <br />Stl~7t Denver, C <br />,~~> <br />(+/_) - - -,- Acres <br />(+/-) - L~ p Acres <br />(+~_) _ - - Acres <br />~^ 6185E <br />:olorado 80203 Tel. (303) 866-3567 <br />