REV03418

• Permit No: C1982056
• IBM Index Class Name: Revision
• Doc Date: 2/5/1996
• Doc Name: APPLICATION FORM FOR A REVISION TO A COAL MINING AND RECLAMATION PERMIT
• Type & Sequence: MR132
• Media Type: D
• Archive: No

III IIIIIIIIIIIIIIII • •
STATE OF COLORADO
DIVISION OF MINERALS AND GEOLOGY
Depanment of Natural Resources
1117 $Frerman 5~.. Room 215
Denier, Colorado 90203
Phnne: X7031866-3567
FAX: [phone] APPLICATION FORM FOR A REVISION
TO A COAL MINING AND RECLAMATION PERMIT DEPARTMF.NI OF
NATURAL
RESOURCES
This form must be completed and submitted with all requests for minor revisions, as defined in Rov comer
Rule 1.04(73), technical revisions, as defined in Rule 1.04(1361, and permit revisions, as defined ~O1ef"D'
in Rule 1.04(90). All revisions are to address the requirements of Rule 2.08.4. Three 131 copies e.K ~ ~~ oih~ o
of the revision, including maps, must be submitted in order for it to be complete.
m~chae~ 8. Land
Dianiun Dne<lur
All revisions are to be formatted so they can be inserted into the permit to replace the revised
sections, maps, tables and/or figures, with a revised table of contents, if necessary. The revision submittal
dace should be printed in the lower right corner of each revision page. A cover letter to the revision should
explain the nature of the revision and reference the specific permit sections being revised.
For federal mines, a copy of the revision application must be submitted to all agencies on the federal mailing
list at the same time the application is submitted to the Division, and proof of distribution must be submitted
tD the Division along with the application. Copies of revision pages modified during the review process must
be distributed in the same manner, along with proof of distribution. Proof of distribution must be submitted
prior to implementation of the revision. For non-federal mines, a copy of the application for which the
Division has issued a proposed approval decision must be submitted to the OSM Western Regional
Coordinating Center 17999 Broadway Blvd., Suite 3320, Denver, CO 80202-5733), and proof of submittal
to OSM must be submitted to the Division prior to implementation of the revision.
Permit No.: C - ~ Z
Permittee: Z ~ ~
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Street: ? 9 5
# 2 7
City: 0 A ~
~ ~ ~ Date: ~ 1 /~ ~ 1 ~ ~
.fL Z ~ .PL 1 S~ ~ - ~_ SL d_ ~ ~~~~
1 5- R 0 U T T -~ .1?` - S 1996,
- - - - - - - - - - OrV rsron °r Murera~9 a OPO~U9r
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State: ~ ~ Zip Code: ~ Q ~ y_ L - - - - -
Brief Description of Revision• INSTALLATION OF POWERLINES TO EMD VENT SHAFTl __
DEWATERING BOREHOLE. E FIBER OPTI L(-S~F AT THE
Public Notice Attached: Yes - No ~ (Required for PRs and TRsI
Bond Increase: Yes ~ No - Federal ~ Non-Federal - Mine
Proposed Change in:
Disturbed Area (+ /-) - - ~ . ~ Acres Affected Area (+/-) - - ~ . ~ Acres
Permit Area (+/-) - - 0 0 Acres Federal Land (+/-(- - 0 . Q Acres
State Land (+/-) - - _p . ~ Acres Private Land (+/-) - - ~ . ~ Acres