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V <br /> OF cO< <br /> o DEPARTMENT OF NATURAL RESOURCES <br /> iaU G (; <br /> � a1�74� d a :, <br /> .,,• rF ;:� ...� • "s• _ - <br /> David H.Getches.Executive Director <br /> MINED LAND RECLAMATION DIVISION <br /> 1g76 * DAVID C.SHELTON, Director � <br /> i <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: _k .2_/ 9 0 <br /> Permittee: M I D - CONT INE N T - - <br /> R C E S - - - - - - <br /> Street: 2 0 1 — C E N T E N N I A L — <br /> S U I T E — 4 0 6 - - - - - - <br /> City: G L E N W 0 0 D — S P R I N G S <br /> - - - - <br /> State: C 0 Zip Code: 8 1 6 0 1 - - - - - <br /> Permi t No. : C - 1 7 - 0 8 1 <br /> This box to be filled in by the Division: <br /> Type of Revision: M R (PR, TR, or MR) <br /> Revision Number 2 9 (Sequential by Revision Type) <br /> Revision Submittal Date 17 /&fiO Date Received by Division) <br /> Revision Completeness Date g _.L/L7 Revision Incompleteness Date <br /> Revision Adequacy Due Date Y/l&/�r Revision Adequacy Date <br /> Revision Decision Due Date fi�/VC7 Fee $0.00 <br /> Brief Description of Revision: P L A C am — O N D — CLEANINGS <br /> O N —CLI_ 4 — R E F U S E — P I L E <br /> Public Notice Attached - Yes No (Required for PR's and TR' s) <br /> Bond Increase: Yes No <br /> Proposed Change in: <br /> Disturbed Area (+/-) — — — — Acres Affected Area (+/-) — — — — Acres <br /> Permit Area (+/-) — — — — Acres Federal Land (+/-) — — — Acres <br /> State Land (+/-) _ _ Acres Private Land (+/-) _ — — Acres <br /> Lead Reclamation Specialist7k_V/ El 'SI <br /> 423 Centennial Building, 1313 Snerman Street Oenve=-. <br />