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��OF C 0�9 <br /> H� 0 DEPARTMENT OF NATURAL RESOURCES <br /> David H.Getches,Executive Director <br /> kN <br /> 11 .11 * MINED LAND RECLAMATION DIVISION <br /> 1876 DAVID C.SHELTON, Director <br /> Richard 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 re i sed. The ;c S �� date '�'�'�'� In pro ntod in the lower right corner of the <br /> revision pages. If necessary, the Table of Contents should'also be revised. <br /> Date: — 1 / _ q �', ws <br /> Permittee: 1 � 1� - � 52 � 1. 1_ � i ,_ - - <br /> � - - MAR 10 1988 <br /> Street: 1? s`,.13 � — .I� r — — — — — W NED LAND <br /> HECLAMATiO N DIVISION, <br /> City: T\ - � 1� - - - - - - - - - - <br /> State: L= -Zip Code: - — — — — <br /> Permi t No. : C - '�' p - [- <br /> This box to be filled in by the Division: <br /> Type of Revision: � i( (PR, TR, or MR) <br /> Revision Number o v(sequential by Revision Type) <br /> Revision Submittal Date 3 //6/PV(Date Received by Division) <br /> Revision Completeness Date _/_/ Revision Incompleteness Date <br /> Revision Adequacy Due Date —I I— Revision Adequacy Date —/ <br /> Revision Decision Due Date 3 Fee $0.00 <br /> Brief Description of Revision: 12� _ \M <br /> Public Notice Attached - Yes No (Required for PR's and TR's) <br /> Bond Increase: Yes No V <br /> Proposed Change in: <br /> Disturbed Area (+/-) — —�. Acres Affected Area (+/-) �i\c—� •— Acres <br /> Permit Area (+/-) — — Acres Federal Land (+/-) ' , c Acres <br /> State Land (+/-) — _ L Acres Private Land (+/-) Acres <br /> Lead Reclamation Specialist L 6185F <br /> 42� C enier,n .I EMuilding, 1313 Sherman Street Denver, Colorado 80203 Tel. (303) 866-3567 <br />