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Richard D. Lamm <br />Govemor <br />Date: <br />Permittee: <br />Street: <br />City: <br />State: <br />Permit <br />DEPARTMENT OF NATURAL RESOURCES <br />David H. Getches, Executive Director <br />MINED LAND RECLAMATION DIVISION <br />DAVID C. SHELTON, Director <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 <br />defined in Rule 1.04(73), technical revisions as defined in Rule 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 />ct Zip Code: _ <br />No.: L - i - C\ <br />Fl CE D <br />AUG 2 1 1989 <br />MINED LAI,"_. <br />RECLAMATION ORnsir,. <br />This box to be filled in by the Division: <br />Type of Revision: b (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: <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,, 6185F <br />423 Centennial Building, 1313 Sherman Street Denver, Colorado 80203 Tel. (303) 866 -3567 <br />