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

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Richard D. Lamm Governor DEPARTMENT OF NATURAL RESOURCES David H. Getches. Executive Director MINED LAND RECLAMATION D1~ 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 Pule 1.04(36) and permit revisions, as defined in Rule 1.04(90). All revisions are to address the requirements of Rul a 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 : ~ 5 / a 3 / ~ ~ _ _ Perini ttee : Lv(L Q =. C- 0 'L' ?-L'V r !U~ - - ~...~5 o U 2C tS~1. N~-- Street: ~ C7~-~..~. X - ~ O 0----- city: C ~+- ~ ~ v iv o ~- ~ ~ ---------- •;tate: C Q ' Zip Code: ~ ~ l ~ oZ 3 - - - - - Permit No.: C - ~ 1 - Q .~ ~ This box to be filled in by the Division: Type of Revision: _ - (PR, TR, or MR) Revision _ Number (Seouential by Revision Type) Revision _ Submittal Date _/ / (Date Received by Division) P.evision Completeness Date / % Revision Incompleteness Date /_/ Revision Adequacy Due Date -/ / Revision Adequacy Date -/ / Revision Decision Due Date / / Fee X0.00 Brief Description of Revision : ~ Q ~ ,,~ ?-~ U C .~ - ~- f C~ 1 f 1 Public Notice Attached - Yes X No (Required for PR's and TR's) Bond Increaser Yes ~ No Proposed Change in: Disturbed Area (+/-) - - L•~ Acres Affected Area (+/-) - - ~ •- Acres ~ermi t Area (+/-) _ - D . 0 Acres Federal Land (+/-) - - Q Acres + Acres Private Land (+/-) L ~,~ Acres State Land ( /-) - - Q Lead Reclamation Specialist ~ N1 = ~6185F 423 Centennial Building, 1313 Sherman Str155 Denver, Colorado 80203 Tel. (303) 866-3567 * y ~~ k i ~~.