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��of cow <br /> y" DEPARTMENT OF NATURAL RESOURCES <br /> David H.Getchett Executive Director <br /> MINED LAND RECLAMATION DIVISION <br /> �876 DAVID C.SHELTON,Director <br /> Richard D.Lamm <br /> Govemor APPLICATION FORM FOR A REVISION <br /> 704 COAL'K NING 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: 0 8/ 0 1 / 8 9 <br /> Perinittee: M I D C 0 N - Z 2L2_ M- Z - - - <br /> R E S 00 -B-C -E -S I -TS-- - <br /> Street: 2 0 _,E_E -NS -E M -ts -A T,-s-. <br /> S U I T E S 4 0 6 - - - - -- <br /> City: G L E N WO .D -I2 -S -E -R -I -X-X - - - - - <br /> State: C o -Zip Code: 8 1 6 0 1 - 0 <br /> Permit No. : C - 8 1 - 0 1 7 <br /> This box to be filled in by the Division: <br /> Type of Revision: _M R(PR, TR, or MR) <br /> Revision Number 2 2 (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: 0 -v- a $ -ii,­&-u-n C 0 -A V -Y, -Y --Q R <br /> S I T E D R A <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 />