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of'cO <br /> op <br /> DEPARTMENT OF NATURAL RESOURCES <br /> 1'1` <br /> y David H.Getche&Executive Director <br /> MINED LAND RECLAMATION DIVISION <br /> 1876 * DAVIDC.SHELTON, Director <br /> J <br /> Richard 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 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 /> Date: 1L 6—/ _1_A/ A 9-- <br /> Permittee: fl-N_ ZZ -1. .E_ _Uz --R -E_ S. <br /> Street: 2 0 1 CENT E N N I -A L —a -T, <br /> SUITE # 4 0 6 <br /> Ci ty: G L E N W 0 JQL D-- -2- P $ 1 .NL GL- -S- <br /> State: 'Zip Code: _L1 (L_ L - <br /> Permit No. : C - Q L?- 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 _ _ (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: C A T C H M E N T B A S I N S <br /> S U T E Y E O P ,S`Q_ I L P L L E <br /> Public Notice Attached - Yes No xx (Required for PR's and TR's) <br /> Bond Increase: Yes No xx <br /> Proposed Change in: <br /> Disturbed Area (+/-) __ _•_ Acres Affected Area (+/-) _ _ _._ Acres <br /> Permit Area W-) _ _ _•_ Acres Federal Land (+/-) _ _ _ Acres <br /> State Land (+/-) _ _ _ Acres Private Land (+/-) _ _ _ Acres <br /> Lead Reclamation Specialist J C S 6185F <br /> 423 Centennial Building, 1313 Sherman Street Denver, Colorado 80203 Tel.(303) 866-3567 <br />