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OF CO4O <br /> DEPARTMENT OF NATURAL RESOURCES <br /> N <br /> i o * David H Getches.Executive Director <br /> ' -W.` * MINED LAND RECLAMATION DIVISION <br /> 1876 DAVID C. SHELTON, Director <br /> Richard D Lamm <br /> Governor 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 <br /> defined in Rule 1 .04(73), technical revisions as defined in Pule 1 .04(36) and permit <br /> revisions, as defined in Rule 1 .04(90). 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 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: <br /> Permittee: L Q N — 1 LIL <br /> -'— t; i •, �.�, tom:,_ "' ,,�, <br /> Street: o. s 2 C — — — — — C f 6 1997 <br /> LAND <br /> — — — — — — 1ECL)AM` k- ,,Jib DIVISION <br /> City: 0 Pi � 4 � - - - - - - - - - - <br /> State: Zip Code: 1 3 - — — —Permit No. : C - , - L 7 <br /> This box to be filled in by the Division: <br /> Type of Revision: — — (PR, TR, or MR) <br /> Revision Number _ _ (Sequential by Revision Type) <br /> Revision Submittal Date _/ / (Date Received by Division) <br /> Revision Completeness Date _/ / Revision Incompleteness Date <br /> Revision Adequacy Due Date —/ / Revision Adequacy Date <br /> Revision Decision Due Date / / Fee $0.00 <br /> Brief Description of Revision: E <br /> Public Notice Attached - Yes No (Required for PR's and TR's) <br /> Bond Increase: Yes i/ No <br /> Proposed Change in: <br /> Disturbed Area (+/-) _ _ .3 Acres Affected Area (+/-) — — — — Acres <br /> Permit Area (+/-) — — . 3 Acres Federal Land (+/-) — — — Acres <br /> State Land (+/-) — — — Acres Private Land (+/-) — — — Acres <br /> Lead Reclamation Specialist — _ — 6185F <br /> 423 Centennial Building, 1313 Sherman Street Denver, Colorado 80203 Tel. (303) 866-3567 <br />