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0-V co� <br /> DEPARTMENT OF NATURAL RESOURCES <br /> David H.Getches,Executive Director <br /> ' -~ MINED LAND RECLAMATION DIVISION <br /> 1876 DAVID C.SHELTON, Director <br /> i <br /> Rwchard 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(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: L 4__/ R 2 <br /> Permittee: M I D _ C o N T I JL_ E.. 1_ 2 — _R_ E S . <br /> Street: 2 0 1 UL _TL .L — _S_ T. <br /> � <br /> ..� 1L —ISZ_ � 4_ lL � - - - - - - t-t <br /> City: -aJA.. E_ ��� � i <br /> State: _0_a -Zip Code: LL � �. __.l - - - - ( (� / r <br /> Permit No. : C - Q .1. 7 <br /> ti <br /> This box to be filled in by the Division: <br /> Type of Revision: M R (PR, TR, or MR) <br /> Revision Number , `) (Sequential by Revision Type) <br /> r• <br /> Revision Submittal Date (Date Received by Division) <br /> Revision Completeness Date /­,5/8,i Revision Incompleteness Date <br /> Revision Adequacy Due Date —/ / Revision Adequacy Date <br /> Revision Decision Due Date 1 / -3/;)'`1 Fee $0.00 <br /> Brief Description of Revision: U S L 2 L _1LL NL T_ N_ _ M — — <br /> _a _U- L_ _ ZL-T E_ g T -a IT Ni N_ E I_ _P_ LL N D S <br /> Public Notice Attached - Yes No y _(Required for PR's and TR's) <br /> Bond Increase: Yes No x <br /> Proposed Change in: <br /> Disturbed Area W-) _ _ e ._ Acres Affected Area (+/-) — — .— Acres <br /> Permit Area W-) _ _ ._ Acres Federal Land (+/-) — — Acres r <br /> State Land (+/-) — — Acres Private Land (+/-) — — C Acres <br /> Lead Reclamation Specialist ___ -G- S— 6185F <br /> 423 Centennial Building, 1313 Sherman Street Denver, Colorado 80203 Tel.(303) 866-3567 <br />