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of Soto <br /> DEPARTMENT OF NATURAL RESOURCES <br /> David H.Getches,Executive Director <br /> MINED LAND RECLAMATION DIVISION <br /> 1876 DAVID C.SHELTON, Director <br /> Richard D.Lamm <br /> Govemor 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(13), 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: M� � =� �19� Z � 1�L � ly � - - � � ) � <br /> CT <br /> Street: . Q _S_ — .�.� 1��Z � �1Ji)-i-2 <br /> t.b .4l�'� . Cr�Sr-1A <br /> City: - - - <br /> State: C c-,i Zip Code: <br /> Pe rmi t No. : C - - <br /> This box to be filled in by the Division: 11L, <br /> Type of Revision: f. 2, (PR, TR, or MR) <br /> i l b Revision Type) <br /> V <br /> Revision Number�. .5(Sequent a y YP <br /> Revision Submittal Date (Date Received by Division) <br /> Revision Completeness Date �c=/ (�/`C`J Revision Incompleteness Date <br /> Revision Adequacy Due Date —/ /_ Revision Adequacy Date <br /> Revision Decision Due Date iC /, `I/ Fee $0.00 <br /> Brief Description of Revision: , �..� c — SILL — <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 Specialist k,1 -L -(:., 6185F <br /> 423 Centennial Building, 1313 Sherman Street Denver, Colorado 80203 Tel.(303) 866-3567 <br />