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of CO <br /> DEPARTMENT OF NATURAL RESOURCES <br /> * � (n * David H.Getches.Executive Director <br /> .,�� * MINED LAND RECLAMATION DIVISION <br /> x 1876 # DAVID C.SHELTON, Director <br /> i <br /> Richard D.Lamm <br /> Govemor APPLICATION FORM FOR A REVISION " <br /> _ <br /> TO A COAL MINING AND RECLAMATION PERMIT <br /> This form must be completed and submieVesionswith <br /> asldefinedrquesin P.ule minor <br /> 04(36)revisions, <br /> permit <br /> defined in Rule 1 .04(73), technical r <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 beinseinserted <br /> into <br /> the the <br /> permitsion t sectaon is <br /> ce e <br /> revised sections, maps, tables and/or figures. Explain <br /> being revised. The revision date should of Contentrinteds shout dn the �al so beg r�.vseder of the <br /> revision pages. If necessary, the Table <br /> Date: �/ 1 4/ g 9 <br /> Pe rmi ttee: _ Q— N-T _- �- F -� - — .R-E S . <br /> Street: 2 0 1 C E <br /> S U I T Et— 4 Q_ � - - - - - - <br /> City: G L E N W -P— E—T �-- S- - - - - - <br /> State: C 0 Zip Code: 8Permit No. : C - 0_ 1 7--IL 1_ <br /> This box to be filled in by the Division: <br /> SCE <br /> Type of Revision: U_ R_ (PR, TR, or MR) <br /> Revision Number `� (Seouential by Revision Type) <br /> Revision Submittal Date /� /=� (Date Received by Division) <br /> Revision Completeness Date / / `� Revision Incompleteness Date <br /> Revision Adequacy Due Date —/ / <br /> Revision Adequacy Date <br /> Revision Decision Due Date / i /�`1 Fee $0.00 <br /> Brief Description of Revision: c �� — — _ <br /> Public Notice Attached - Yes No XX (Required for PR's and TR's) <br /> Bond Increase: Yes No xx <br /> Proposed Change in: Acres Acres <br /> Disturbed Area (+/-) — — —•— Acres Affected Area (+/-) — — ._•— <br /> Acres Federal Land (+/-) _ — — <br /> Permit Area (+/-) — — .._•— Acres <br /> State Land (+/-) —— — Acres Private Land (+/-) — — _ <br /> 6185E <br /> Lead Reclamation Specialist J C S <br /> 423 Centennial Building, 1313 Sherman Street Denver, Colorado 80203 Tel. (303) 866-3567 <br />