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OF.CO <br /> DEPARTMENT OF NATURAL RESOURCES <br /> David H.Getches,Executive Director <br /> ' v * MINED LAND RECLAMATION DIVISION <br /> a 1876 * DAVID C.SHELTON, Director <br /> Rwchard 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 /> NOISIA10 N0IlbWVl03hj <br /> Date: (INV103NIW <br /> Permittee: M I D = -.C- Q .ULL --L r .. _U_ z - - 6861 � T inn <br /> Street: 2 0 1 ,� _L Jj_ _LL .T_.E_ -UL _t L A _L_ <br /> S U I T E # 4 0r2_ - - - - - - <br /> City: G L -F.L- 11L16LQ -L .I1. -aP_ PL 1\1 .- S - - - - - <br /> State: Q ,Zip Code: — <br /> Permi t No. : C - 0 1 7- 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'�P ► (Sequential by Revision Type) <br /> Revision Submittal Date 7//';/gy (Date Received by Division) <br /> Revision Completeness Date "1 /%/� ' Revision Incompleteness Date <br /> Revision Adequacy Due Date —/ / Revision Adequacy Date <br /> Revision Decision Due Date /21/94 Fee $0.00 <br /> P <br /> Brief Description of Revision: U S E -a Z <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 (+/-) — — 0 .— Acres Affected Area (+/-) — — 0 .— Acres <br /> Permit Area (+/-) _ _ D . Acres Federal Land (+/-) — — 0 Acres <br /> State Land (+/-) 0 Acres Private Land (+/-) _ — Acres <br /> Lead Reclamation Specialist W b U 6185F <br /> 423 Centennial Building, 1313 Sherman Street Denver, Colorado 80203 Tel.(303) 866-3567 <br />