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F'O Ell EF'T DELH['dE''` TEL 1--lo . ^Ci I IC t . I 'i : 111 F <br /> STATE aF COLORADO <br /> MINED LAND RECLAMATION DIVISION C <br /> Deparlmew of Natural Resources <br /> 1313 ShermanS' Room?IS '�• <br /> DpnV tr CO 8OZ03 <br /> 30? 866.3567 �r �e <br /> FAX 3G3 812.6106 <br /> Crovama <br /> Fr*d Ft 9arna, <br /> APPLICATION FORM FOR A REYISION DovmonD7f:1or <br /> TO A COAL MINING AND RECLAMATION PERMIT <br /> This form must be completed and submitted with aTl requests for minor <br /> revisions , as defined it Rule 1 .04(73), technical revisions as defined in <br /> Rule 1 .04(36) and permit revisions , as defined in Rule 1 .04(90) . All <br /> revisions are to addres<: the requirements of Rule 2 .08.4. Three (3) copies of <br /> your revision including maps must be submitted in order for it to be complete. <br /> All revisions are to be formatted so they can be inserted into the permit to <br /> rep4ce to a revised sections, maps , tables and/or figures. Explain in the <br /> revision what section is being revised. The revision date should be printed <br /> in the lower right cornf.r of the revision pages. Tf necessary, the Table of <br /> Conten,s should also be revised. When the final version of the revision is <br /> approved, 7 copies must be sent to OSM in Denver for Federal mines and for <br /> non--Federal mines 1 cop), must be sent to OSM at 62S Silver Avenue, SW, Suite <br /> 310, Albuquerque, New Mexico 87102. The revision may not proceed until OSIM <br /> has been provided copies. Copies should be sent certified mail . <br /> Permit No. : C - 8 1 - 0 1 7 <br /> D'I to: 1 0 / 2 2�/ 9 1_„- <br /> Permitttie: ; 1:�, 7 riYri. �E'sat.u6iC �- <br /> Street: 8188 .Sa0 La'dsL ..^ --- -- — -- --- <br /> City: G1.erugc)oil L4;t1n;;--, <br /> State Zip i;ode: 81602 <br /> Mine Name: � �Lj;_H".p" "ji <br /> Brief Description of Recision: <br /> public Notice Attached - Yes No X� (Required for PR's and TR's) <br /> Bond Increase: Yes No Federal Non-Federal Mine <br /> Proposed Change in: <br /> Disturbed Area {t/- ) — Acres Affected Area {+/-) Acres <br /> Permit Area (+f-) Acres Federal Land (+/-) Acres <br /> State Land (t/-} _ Acres Private Land (t/-) Acres <br /> 6185E (10,190) <br />