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Surface Private <br />Surface Federal <br />Surface State <br />COLORADO DIVISION OF RECLAMATION, MINING AND SAFETY <br />1313 Sherman Street, Room 215, Denver, Colorado 80203, (303) 866 -3567 <br />APPLICATION FORM FOR A REVISION <br />TO A COAL MINING AND RECLAMATION PERMIT <br />This form must be completed and submitted with all requests for minor revisions, as defined in Rule 1.04(73), technical <br />revisions, as defined in Rule 1.04(136), and permit revisions, as defined in Rule 1.04(90). All revisions are to address the <br />requirements of Rule 2.08.4. Three (3) copies of the revision, including maps, must be submitted in order for it to be <br />complete. <br />All revisions are to be formatted so they can be inserted into the permit to replace the revised sections, maps, tables and/or <br />figures, with a revised table of contents, if necessary. The revision submittal date should be printed in the lower right comer of <br />each revision page. A cover letter to the revision should explain the nature of the revision and reference the specific permit <br />sections being revised. <br />For federal mines, a copy of the revision application must be submitted to all agencies on the federal mailing list (except OSM) <br />at the same time the application is submitted to the Division, and proof of distribution must be submitted to the Division along <br />with the application. Copies of revision pages modified during the review process must be distributed in the same manner, <br />along with proof of distribution. Proof of distribution must be submitted prior to implementation of the revision. <br />Permit No.: C- 2009 -087 Date: August 29, 2011 <br />Permittee: Peabody Sage Creek Coal Company <br />Street: 36600 RCR 27 <br />City: Hayden <br />State: Colorado Zip Code: 81639 <br />Brief Description of Revision: Septic Profile Pits, Domestic Water Test Well, Power Installation <br />and Transfer of Public Copy of Mining Permit from the Routt County Court House to the <br />Hayden Public Library <br />Public Notice Attached: Yes _ No X (Required for PRs and TRs) <br />Bond Increase: Yes X No Federal Non - Federal X Mine <br />Proposed Change in: <br />Permit Area - <br />Disturbed ( + / -) 0.0 Acres <br />Permit ( + / -) + 0.0 Acres <br />Affected ( + / -) 0.0 Acres <br />Surface Ownership - Mineral Ownership - <br />( + / -) 0.0 Acres <br />( + / -) 0.0 Acres <br />( + / -) 0.0 Acres <br />Mineral Private <br />Mineral Federal <br />Mineral State <br />( + / -) 0.0 Acres <br />( + / -) 0.0 Acres <br />( + / -) 0.0 Acres <br />